Provider Demographics
NPI:1932735578
Name:FINNEGAN-FINCK, KATHRYN AMANDA (LMT)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:AMANDA
Last Name:FINNEGAN-FINCK
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-2105
Mailing Address - Country:US
Mailing Address - Phone:516-835-4322
Mailing Address - Fax:
Practice Address - Street 1:104 BENKERT ST
Practice Address - Street 2:
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714-3002
Practice Address - Country:US
Practice Address - Phone:516-490-9085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-16
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY02415401225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02415401OtherDEPARTMENT OF EDUCATION