Provider Demographics
NPI:1326321092
Name:STRUCKMANN, KATHLEEN B (EDM)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:B
Last Name:STRUCKMANN
Suffix:
Gender:F
Credentials:EDM
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:B
Other - Last Name:FRAWLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EDM
Mailing Address - Street 1:80 WARDMAN RD
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14217-2728
Mailing Address - Country:US
Mailing Address - Phone:716-876-5738
Mailing Address - Fax:
Practice Address - Street 1:2900 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217-2309
Practice Address - Country:US
Practice Address - Phone:716-871-9883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYCONTROL # 549665041174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist