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NPI Code Detail

MEDICARE: KRISTIN GAVIN

MEDICARE: KRISTIN GAVIN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist071408NY

General Provider Information

NPI Number : 1356678353
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTIN GAVIN
Provider Business Mailing Address
First Line : 67 RALPH AVE
Second Line :
City : BABYLON
State : NY
Zip : 11702-2117
Country : US
Telephone Number : 631-539-9874
Fax Number :
Provider Business Practice Location Address
First Line : 138 READE ST
Second Line :
City : NEW YORK
State : NY
Zip : 10013-3968
Country : US
Telephone Number : 212-608-9661
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/11/2009
Last Update Date : 08/30/2012

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Directions to “ KRISTIN GAVIN ” Practice Location

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