Healthcare Provider Details

I. General information

NPI: 1124122304
Provider Name (Legal Business Name): JOY LYNN KREEGER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 06/19/2023
Certification Date: 06/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

484 MAIN ST
EAST AURORA NY
14052-1716
US

IV. Provider business mailing address

484 MAIN ST
EAST AURORA NY
14052-1716
US

V. Phone/Fax

Practice location:
  • Phone: 716-805-1717
  • Fax: 716-805-1719
Mailing address:
  • Phone: 716-805-1717
  • Fax: 716-805-1719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number186718-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number186718-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: