Provider Demographics
NPI:1639286248
Name:ALBOHM, KATHLEEN C (NP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:C
Last Name:ALBOHM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:17E 102ND ST
Mailing Address - Street 2:BOX 1087
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-5204
Mailing Address - Country:US
Mailing Address - Phone:212-659-8551
Mailing Address - Fax:212-426-0255
Practice Address - Street 1:1470 MADISON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6574
Practice Address - Country:US
Practice Address - Phone:212-241-0863
Practice Address - Fax:212-831-8116
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYF300409363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily