Provider Demographics
NPI:1134546500
Name:DELTOSTA, KIM (BA, MS)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:DELTOSTA
Suffix:
Gender:F
Credentials:BA, MS
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 135
Mailing Address - Street 2:
Mailing Address - City:BROWNVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13615-0135
Mailing Address - Country:US
Mailing Address - Phone:315-771-6637
Mailing Address - Fax:
Practice Address - Street 1:159 W 1ST ST
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-2045
Practice Address - Country:US
Practice Address - Phone:315-342-9575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-24
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY581649111174400000X
NY581650111174400000X
NY665462121174400000X
NY665461121174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist