Basic Information
| Provider Information | |||||||||
| NPI: | 1184038069 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | OWENS | ||||||||
| FirstName: | KIMBERLY | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 711 TROY SCHENECTADY RD STE 201 | ||||||||
| Address2: | |||||||||
| City: | LATHAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 121102461 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1783 ROUTE 9 STE 104 | ||||||||
| Address2: | |||||||||
| City: | HALFMOON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 120652465 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5188362428 | ||||||||
| FaxNumber: | 5188362413 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2014 | ||||||||
| LastUpdateDate: | 05/05/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085B0100X | 303613 | NY | Y | Allopathic & Osteopathic Physicians | Radiology | Body Imaging |
No ID Information.