1316298375 NPI number — MRS. KATHARINE HAXALL CRONIN MS, MPH, CPNP

Table of content: (NPI 1457836710)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316298375 NPI number — MRS. KATHARINE HAXALL CRONIN MS, MPH, CPNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRONIN
Provider First Name:
KATHARINE
Provider Middle Name:
HAXALL
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS, MPH, CPNP
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:
1316298375
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/15/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7 2ND PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GARDEN CITY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11530-6118
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-302-5000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1111 MONTAUK HWY
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
WEST ISLIP
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11795-4910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-661-2510
Provider Business Practice Location Address Fax Number:
631-669-6502
Provider Enumeration Date:
09/30/2012

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: 163W00000X , with the licence number:  6435541 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0200X , with the licence number: 382344 , 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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