Provider Demographics
NPI:1134347230
Name:KENDAL AT ITHACA
Entity type:Organization
Organization Name:KENDAL AT ITHACA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH SERVICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCKLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-272-5300
Mailing Address - Street 1:105 N SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1459
Mailing Address - Country:US
Mailing Address - Phone:607-272-5464
Mailing Address - Fax:
Practice Address - Street 1:2230 N TRIPHAMMER RD
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-6513
Practice Address - Country:US
Practice Address - Phone:607-266-5300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY01740-1261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy