Organization
KINGSTON AMBULATORY SURGICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KATHLEEN KELLY (ADMINISTRATOR/CEO)
(845) 338-4777
Entity
Organization
Contact information
Practice address
40 HURLEY AVE, SUITE 13, KINGSTON, NY 12401-3739
(845) 338-4777
(845) 339-7339
Mailing address
40 HURLEY AVE, SUITE 13, KINGSTON, NY 12401-3739
(845) 338-4777
(845) 339-7339
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
5501210R
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
178394
—
NY
01
—
5501210R
NYS DOH LICENSE #
NY
Enumeration date
08/05/2006
Last updated
08/25/2015
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