Healthcare Provider Details

I. General information

NPI: 1538832142
Provider Name (Legal Business Name): KRISTEN SUZANNE SERGI AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2021
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 WATERS PL STE 110
BRONX NY
10461-0371
US

IV. Provider business mailing address

660 WHITE PLAINS RD FL ENTA4
TARRYTOWN NY
10591-5139
US

V. Phone/Fax

Practice location:
  • Phone: 718-863-4366
  • Fax:
Mailing address:
  • Phone: 914-333-5801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number003034
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: