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General NPI Number Information
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NPI Number | 1437223153
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Entity Type | Organization
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Legal Business Name | KINGSTON UROLOGICAL ASSOCIATES
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Dates
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Enumeration Date | 11/17/2006
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Last Update Date | 02/12/2016
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Provider Practice Location Address
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Address Line | 40 HURLEY AVE SUITE 17
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City | KINGSTON
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State | NY
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Zip | 12401-3739
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Country | US
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Telephone | 845-339-6022
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Fax | 845-339-5467
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Provider Business Mailing Address
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Address Line | 40 HURLEY AVE SUITE 17
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City | KINGSTON
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State | NY
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Zip | 12401-3739
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Country | US
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Telephone | 845-339-6022
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Fax | 845-339-5467
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | DR. THOMAS V STELLATO
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Credential | M.D.
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Telephone | 845-339-6022
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 116375-1
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License Number State | NY
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