Provider Demographics
NPI:1023191533
Name:KINEKE, STEPHEN F (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:F
Last Name:KINEKE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:711 TROY SCHENECTADY RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2442
Mailing Address - Country:US
Mailing Address - Phone:518-782-3700
Mailing Address - Fax:518-782-3799
Practice Address - Street 1:1783 ROUTE 9
Practice Address - Street 2:SUITE 202
Practice Address - City:HALFMOON
Practice Address - State:NY
Practice Address - Zip Code:12065-2409
Practice Address - Country:US
Practice Address - Phone:518-383-2366
Practice Address - Fax:518-383-6022
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-21
Last Update Date:2023-03-07
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Provider Licenses
StateLicense IDTaxonomies
NY172443207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY172443OtherSTATE LICENSE NUMBER
NY01160127Medicaid
NY1189201OtherDEA
NY172443OtherSTATE LICENSE NUMBER
NY1189201OtherDEA