Provider Demographics
NPI:1891108163
Name:MULVANA, KYLE W (CPO)
Entity Type:Individual
Prefix:MR
First Name:KYLE
Middle Name:W
Last Name:MULVANA
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 236
Mailing Address - Street 2:
Mailing Address - City:CHATEAUGAY
Mailing Address - State:NY
Mailing Address - Zip Code:12920-0236
Mailing Address - Country:US
Mailing Address - Phone:518-497-8007
Mailing Address - Fax:518-497-7009
Practice Address - Street 1:45 RIVER ST
Practice Address - Street 2:
Practice Address - City:CHATEAUGAY
Practice Address - State:NY
Practice Address - Zip Code:12920-2003
Practice Address - Country:US
Practice Address - Phone:518-497-8007
Practice Address - Fax:518-497-7009
Is Sole Proprietor?:No
Enumeration Date:2014-06-04
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYCPO025551744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management