Provider Demographics
NPI:1750643045
Name:ABBATIELLO, KATHRYN M (MS)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:M
Last Name:ABBATIELLO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:562 KIME AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-1117
Mailing Address - Country:US
Mailing Address - Phone:631-254-1563
Mailing Address - Fax:
Practice Address - Street 1:562 KIME AVE
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-1117
Practice Address - Country:US
Practice Address - Phone:631-254-1563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1506513174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist