Provider Demographics
NPI:1689362394
Name:HASTINGS, KYLE JOSEPH
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:JOSEPH
Last Name:HASTINGS
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 1:4544 NE TOWNLINE RD
Mailing Address - Street 2:
Mailing Address - City:MARCELLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13108-9717
Mailing Address - Country:US
Mailing Address - Phone:315-456-8734
Mailing Address - Fax:
Practice Address - Street 1:4544 NE TOWNLINE RD
Practice Address - Street 2:
Practice Address - City:MARCELLUS
Practice Address - State:NY
Practice Address - Zip Code:13108-9717
Practice Address - Country:US
Practice Address - Phone:315-456-8734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program