Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 304318 | NY |
NPI | 1003279712 |
---|---|
Provider Name | Kelsey Kredentser |
First Address | New Hyde Park, NY 11040-5031 |
Second Address | New Hyde Park, NY 11040-1759 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2016 |
Last Update Date | 20/08/2020 |