Healthcare Provider Details

I. General information

NPI: 1265204788
Provider Name (Legal Business Name): KRISTINA MAGIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2023
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3314 BUFFALO ST
ALEXANDER NY
14005-9701
US

IV. Provider business mailing address

11 HUNTER ST
BERGEN NY
14416-9527
US

V. Phone/Fax

Practice location:
  • Phone: 585-591-1551
  • Fax:
Mailing address:
  • Phone: 315-941-1453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number034994
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: