Provider Demographics
NPI:1083618920
Name:ALLEN AQUILANTE, KATHY L (OD)
Entity Type:Individual
Prefix:DR
First Name:KATHY
Middle Name:L
Last Name:ALLEN AQUILANTE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:L ALLEN-
Other - Last Name:AQUILANTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:64 WATTS ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-1934
Mailing Address - Country:US
Mailing Address - Phone:718-945-9376
Mailing Address - Fax:718-945-9376
Practice Address - Street 1:64 WATTS ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-1934
Practice Address - Country:US
Practice Address - Phone:718-945-9376
Practice Address - Fax:718-945-9376
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV005545-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC8R05-2Medicare PIN
NYC8R05-1Medicare PIN
NYU52751Medicare UPIN
NYC8R05Medicare PIN