Provider Demographics
NPI:1548294796
Name:KINGSTON INTERNAL MEDICINE ASSOCIATES, P.C.
Entity type:Organization
Organization Name:KINGSTON INTERNAL MEDICINE ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:KEMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-338-2727
Mailing Address - Street 1:368 BROADWAY STE 403
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-5160
Mailing Address - Country:US
Mailing Address - Phone:845-338-2727
Mailing Address - Fax:845-338-2975
Practice Address - Street 1:368 BROADWAY STE 403
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-5160
Practice Address - Country:US
Practice Address - Phone:845-338-2727
Practice Address - Fax:845-338-2975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY149865173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01267463Medicaid
NY01267463Medicaid