Provider Demographics
NPI:1659504207
Name:OSMAN, KATHLEEN (RPA-C)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:OSMAN
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 VAN COTT RD
Mailing Address - Street 2:SUITE 2E
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-6519
Mailing Address - Country:US
Mailing Address - Phone:631-274-0777
Mailing Address - Fax:
Practice Address - Street 1:50 NEW YORK AVE # 25A
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-3448
Practice Address - Country:US
Practice Address - Phone:631-862-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-31
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013477-1363AM0700X
NY013477363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical