Individual
TAMMY KILEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
456 N PEARL ST, MENANDS, NY 12204-1511
(518) 462-5923
(518) 641-0425
Mailing address
456 N PEARL ST, MENANDS, NY 12204-1511
(518) 462-5923
(518) 641-0425
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
39438
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04224448
—
NY
Enumeration date
08/22/2016
Last updated
08/22/2016
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