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NPI Code Detail

MEDICARE: KATHLEEN PHILLIPS MA

MEDICARE: KATHLEEN PHILLIPS MA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174H00000XHealth Educator
2174400000XSpecialist

General Provider Information

NPI Number : 1689095846
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHLEEN PHILLIPS MA
Provider Business Mailing Address
First Line : 354 AVENUE A
Second Line :
City : RONKONKOMA
State : NY
Zip : 11779-1940
Country : US
Telephone Number : 631-816-1106
Fax Number :
Provider Business Practice Location Address
First Line : 225 BROADHOLLOW RD STE 402
Second Line :
City : MELVILLE
State : NY
Zip : 11747-4899
Country : US
Telephone Number : 631-385-7780
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/13/2013
Last Update Date : 07/11/2019

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Directions to “ KATHLEEN PHILLIPS MA” Practice Location

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