1194381046 NPI number — KRISTINA CARMELA SMORTO-KASPER RN

Table of content: KRISTINA CARMELA SMORTO-KASPER RN (NPI 1194381046)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194381046 NPI number — KRISTINA CARMELA SMORTO-KASPER RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMORTO-KASPER
Provider First Name:
KRISTINA
Provider Middle Name:
CARMELA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KASPER
Provider Other First Name:
KRISTINA
Provider Other Middle Name:
CAREMELA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1194381046
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/16/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
351 PROSPECT AVE APT 1R
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11215-5532
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-940-9184
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
351 PROSPECT AVE APT 1R
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11215-5532
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-940-9184
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/16/2019

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: 163W00000X , with the licence number:  553451 , 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)





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