Provider Demographics
NPI:1700200615
Name:PADALINO, KATHRYN REBECCA (RN)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:REBECCA
Last Name:PADALINO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 WEATHERWAX RD
Mailing Address - Street 2:
Mailing Address - City:AVERILL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12018-5921
Mailing Address - Country:US
Mailing Address - Phone:518-466-7999
Mailing Address - Fax:
Practice Address - Street 1:345 WEATHERWAX RD
Practice Address - Street 2:
Practice Address - City:AVERILL PARK
Practice Address - State:NY
Practice Address - Zip Code:12018-5921
Practice Address - Country:US
Practice Address - Phone:518-466-7999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-12
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01379024Medicaid