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General NPI Number Information
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NPI Number | 1467490680
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Entity Type | Individual
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Provider Name | ANDREW KEARNEY PA
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Gender | Male
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Dates
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Enumeration Date | 06/02/2006
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Last Update Date | 02/10/2010
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Provider Practice Location Address
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Address Line | 2 BROAD STREET PLZ
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City | GLENS FALLS
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State | NY
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Zip | 12801-4363
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Country | US
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Telephone | 518-926-1770
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Fax | 518-926-1799
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Provider Business Mailing Address
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Address Line | PO BOX 304
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City | GLENS FALLS
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State | NY
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Zip | 12801-0304
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Country | US
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Telephone | 518-926-6999
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Fax | 518-926-6984
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 0078701
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 007870
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License Number State | NY
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