Basic Information
| Provider Information | |||||||||
| NPI: | 1194141564 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HUNTLEY | ||||||||
| FirstName: | KATHLEEN | ||||||||
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| Credential: | P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 GARDEN CITY PLZ | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | GARDEN CITY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115303301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5166636400 | ||||||||
| FaxNumber: | 5166636401 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 GARDEN CITY PLZ | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | GARDEN CITY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115303301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5166636400 | ||||||||
| FaxNumber: | 5166636401 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2014 | ||||||||
| LastUpdateDate: | 03/10/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 017161 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.