Healthcare Provider Details

I. General information

NPI: 1750365797
Provider Name (Legal Business Name): KRISTIN LEE BRUNING MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 08/16/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 E MAIN ST
HUNTINGTON NY
11743-2863
US

IV. Provider business mailing address

PO BOX 350
CENTERPORT NY
11721-0350
US

V. Phone/Fax

Practice location:
  • Phone: 631-923-1272
  • Fax: 631-498-0508
Mailing address:
  • Phone: 631-923-1272
  • Fax: 631-498-0508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number201268
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: