Healthcare Provider Details

I. General information

NPI: 1427278373
Provider Name (Legal Business Name): KRISTIN SNYDER MOLTZ P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 EASTCHESTER RD
BRONX NY
10461-2301
US

IV. Provider business mailing address

6718 EXETER ST
FOREST HILLS NY
11375-4151
US

V. Phone/Fax

Practice location:
  • Phone: 718-904-3415
  • Fax: 718-904-3449
Mailing address:
  • Phone: 718-268-9143
  • Fax: 718-268-9143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number005496-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: