Healthcare Provider Details

I. General information

NPI: 1144391889
Provider Name (Legal Business Name): KRISTEN E ROBILLARD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 03/19/2021
Certification Date: 03/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 E MAIN ST
ENDICOTT NY
13760-4925
US

IV. Provider business mailing address

415 E MAIN ST
ENDICOTT NY
13760-4925
US

V. Phone/Fax

Practice location:
  • Phone: 607-785-2460
  • Fax: 607-785-2584
Mailing address:
  • Phone: 607-785-2460
  • Fax: 607-785-2584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number193513
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: