1417998246 NPI number — KRISTINA CARR PA-C

Table of content: KRISTINA CARR PA-C (NPI 1417998246)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417998246 NPI number — KRISTINA CARR PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARR
Provider First Name:
KRISTINA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HEITZMAN
Provider Other First Name:
KRISTINA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1417998246
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/13/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
969 MAIN ST STE D
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FISHKILL
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12524-1791
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-896-7730
Provider Business Mailing Address Fax Number:
845-896-7758

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
40 HURLEY AVE STE 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINGSTON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
453-383-2008
Provider Business Practice Location Address Fax Number:
845-338-3233
Provider Enumeration Date:
06/10/2006

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: 363A00000X , with the licence number:  0028871 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01819896 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com