Healthcare Provider Details

I. General information

NPI: 1750521415
Provider Name (Legal Business Name): DENISE M KOEMM RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2009
Last Update Date: 02/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 UNION CENTER RD
ULSTER PARK NY
12487
US

IV. Provider business mailing address

91 UNION CENTER RD
ULSTER PARK NY
12487
US

V. Phone/Fax

Practice location:
  • Phone: 845-338-3690
  • Fax: 845-338-3690
Mailing address:
  • Phone: 845-338-3690
  • Fax: 845-338-3690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number6271192
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: