Provider Demographics
NPI:1891718995
Name:PANDOLIANO, KITTY (PT)
Entity Type:Individual
Prefix:
First Name:KITTY
Middle Name:
Last Name:PANDOLIANO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 DOGWOOD LN
Mailing Address - Street 2:
Mailing Address - City:CORNWALL
Mailing Address - State:NY
Mailing Address - Zip Code:12518-2144
Mailing Address - Country:US
Mailing Address - Phone:845-534-5913
Mailing Address - Fax:
Practice Address - Street 1:664 STONELEIGH AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512-3940
Practice Address - Country:US
Practice Address - Phone:845-534-5913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012822174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist