Provider Demographics
NPI:1285267195
Name:KAZOLIAS KEMPF, ELLEN
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:KAZOLIAS KEMPF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 SPRING AVE
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-4741
Mailing Address - Country:US
Mailing Address - Phone:518-813-3007
Mailing Address - Fax:
Practice Address - Street 1:770 EMBOUGHT RD
Practice Address - Street 2:
Practice Address - City:CATSKILL
Practice Address - State:NY
Practice Address - Zip Code:12414-5312
Practice Address - Country:US
Practice Address - Phone:518-943-0574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-19
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist