1528326279 NPI number — KRISTIN ANN STROPNICKY D.O.

Table of content: KRISTIN ANN STROPNICKY D.O. (NPI 1528326279)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528326279 NPI number — KRISTIN ANN STROPNICKY D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STROPNICKY
Provider First Name:
KRISTIN
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528326279
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/04/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
346 GRAND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JOHNSON CITY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13790-2580
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
607-763-6075
Provider Business Mailing Address Fax Number:
607-763-5234

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2040 ROUTE 33
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEPTUNE CITY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07753-6103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-455-5800
Provider Business Practice Location Address Fax Number:
732-455-5804
Provider Enumeration Date:
05/01/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  25MB09840800 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)