Dercola, Kelly S
Dercola, Kelly S is an individual health care provider with primary practice located at 368 Broadway , Kingston NY 12401-5144. She recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as her primary health care specialty. Dercola, Kelly S can be contacted via phone (845) 338-2727.Contact Information
Primary practice address
368 Broadway
Kingston NY 12401-5144
Phone: (845) 338-2727
Fax: (845) 338-2975
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 195587-1 | New York |
Profile Details
| NPI number | 1376523688 |
|---|---|
| LBN Legal business name | Dercola, Kelly S |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 20th, 2006 |
| Last updated | Jul 8th, 2007 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1376523688 | NPPES |
| New York | MEDICAID | 01565526 | |
| New York | Other | 117150 |
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