Provider Demographics
NPI:1427096742
Name:USMANI, KATHLEEN C (CPNP)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:C
Last Name:USMANI
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1559
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790
Mailing Address - Country:US
Mailing Address - Phone:631-444-8115
Mailing Address - Fax:631-444-6045
Practice Address - Street 1:100 NICHOLS RD
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790
Practice Address - Country:US
Practice Address - Phone:631-444-8115
Practice Address - Fax:631-444-8115
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF381700363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02685147Medicaid
NY02685147Medicaid
NY1361G1Medicare ID - Type Unspecified