=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295726917
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BARBARA A. KILKENNY, DPM
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/02/2005
-----------------------------------------------------
Last Update Date | 07/22/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2 POMPERAUG OFFICE PARK SUITE 106
-----------------------------------------------------
City | SOUTHBURY
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06488-2288
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-264-0800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2 POMPERAUG OFFICE PARK SUITE 106
-----------------------------------------------------
City | SOUTHBURY
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06488-2288
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-264-0800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | BARBARA A KILKENNY
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 203-264-0800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | 000528
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------