Provider Demographics
NPI:1578287249
Name:KILKENNY, KALEB
Entity Type:Individual
Prefix:
First Name:KALEB
Middle Name:
Last Name:KILKENNY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:RENSSELAER
Mailing Address - State:NY
Mailing Address - Zip Code:12144-2927
Mailing Address - Country:US
Mailing Address - Phone:518-961-3242
Mailing Address - Fax:
Practice Address - Street 1:8 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:RENSSELAER
Practice Address - State:NY
Practice Address - Zip Code:12144-2927
Practice Address - Country:US
Practice Address - Phone:518-961-3242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006320171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist