Provider Demographics
NPI:1841550225
Name:NEWFROCK, KATHLEEN MARY (RN)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:MARY
Last Name:NEWFROCK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 COLUMBIA DR
Mailing Address - Street 2:
Mailing Address - City:ENDWELL
Mailing Address - State:NY
Mailing Address - Zip Code:13760-2306
Mailing Address - Country:US
Mailing Address - Phone:607-754-4441
Mailing Address - Fax:
Practice Address - Street 1:1040 CONKLIN RD
Practice Address - Street 2:
Practice Address - City:CONKLIN
Practice Address - State:NY
Practice Address - Zip Code:13748-1136
Practice Address - Country:US
Practice Address - Phone:607-775-9108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY512565-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01505531Medicaid