Provider Demographics
NPI:1326073859
Name:KINDLON, MARCIA J (NP)
Entity Type:Individual
Prefix:MS
First Name:MARCIA
Middle Name:J
Last Name:KINDLON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 NEW SALEM RD
Mailing Address - Street 2:
Mailing Address - City:VOORHEESVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12186-4833
Mailing Address - Country:US
Mailing Address - Phone:518-466-3035
Mailing Address - Fax:
Practice Address - Street 1:680 NEW SALEM RD
Practice Address - Street 2:
Practice Address - City:VOORHEESVILLE
Practice Address - State:NY
Practice Address - Zip Code:12186-4833
Practice Address - Country:US
Practice Address - Phone:518-466-3035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY331684363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01804306Medicaid
NYS50153Medicare UPIN
NY01804306Medicaid