Provider Demographics
NPI:1821351123
Name:KILKENNY-MCMAHON, BRIDIE P
Entity Type:Individual
Prefix:MRS
First Name:BRIDIE
Middle Name:P
Last Name:KILKENNY-MCMAHON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 COACHMAN LN
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-4348
Mailing Address - Country:US
Mailing Address - Phone:516-520-0952
Mailing Address - Fax:
Practice Address - Street 1:49 COACHMAN LN
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-4348
Practice Address - Country:US
Practice Address - Phone:516-520-0952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist