Provider Demographics
NPI:1992725279
Name:ADVANCED DERMATOLOGY, PLLC
Entity type:Organization
Organization Name:ADVANCED DERMATOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:T
Authorized Official - Last Name:KIRCHER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:845-339-2525
Mailing Address - Street 1:301 HURLEY AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-2416
Mailing Address - Country:US
Mailing Address - Phone:845-339-2525
Mailing Address - Fax:
Practice Address - Street 1:301 HURLEY AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-2416
Practice Address - Country:US
Practice Address - Phone:845-339-2525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWFW151Medicare PIN