Provider Demographics
NPI:1205217767
Name:KINNEARY, JANE
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:KINNEARY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 COUNTY ROAD 2
Mailing Address - Street 2:
Mailing Address - City:GREENE
Mailing Address - State:NY
Mailing Address - Zip Code:13778-2290
Mailing Address - Country:US
Mailing Address - Phone:607-242-1772
Mailing Address - Fax:
Practice Address - Street 1:254 COUNTY ROAD 2
Practice Address - Street 2:
Practice Address - City:GREENE
Practice Address - State:NY
Practice Address - Zip Code:13778-2290
Practice Address - Country:US
Practice Address - Phone:607-242-1772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-10
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0212231124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist