Basic Information
| Provider Information | |||||||||
| NPI: | 1356409551 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MANDY | ||||||||
| FirstName: | KATHLEEN | ||||||||
| MiddleName: | K. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 WESTAGE BUSINESS CTR DR | ||||||||
| Address2: | |||||||||
| City: | FISHKILL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125242281 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8452315600 | ||||||||
| FaxNumber: | 8452315489 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 WESTAGE BUSINESS CTR DR | ||||||||
| Address2: | |||||||||
| City: | FISHKILL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125242281 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8452315560 | ||||||||
| FaxNumber: | 8452315489 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/04/2006 | ||||||||
| LastUpdateDate: | 04/29/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 211574 | NY | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.