Provider Demographics
NPI:1619598927
Name:KAMELOT INC
Entity type:Organization
Organization Name:KAMELOT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/FPMHNP
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MARSZALEK
Authorized Official - Suffix:
Authorized Official - Credentials:FPMHNP
Authorized Official - Phone:845-672-3292
Mailing Address - Street 1:67 BALL ST
Mailing Address - Street 2:
Mailing Address - City:PORT JERVIS
Mailing Address - State:NY
Mailing Address - Zip Code:12771-2524
Mailing Address - Country:US
Mailing Address - Phone:845-672-3292
Mailing Address - Fax:
Practice Address - Street 1:690 NY 211 EAST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10941
Practice Address - Country:US
Practice Address - Phone:845-672-3292
Practice Address - Fax:845-672-3393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-28
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)