Healthcare Provider Details

I. General information

NPI: 1790768232
Provider Name (Legal Business Name): CINDY C. KREISBERG RPAC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 BEDFORD PARK BLVD W T-3, ROOM 118
BRONX NY
10468-1527
US

IV. Provider business mailing address

323 STRATTON RD
NEW ROCHELLE NY
10804-1441
US

V. Phone/Fax

Practice location:
  • Phone: 718-960-8902
  • Fax: 718-960-8909
Mailing address:
  • Phone: 914-576-3550
  • Fax: 718-960-8909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1607-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: