Healthcare Provider Details

I. General information

NPI: 1639323660
Provider Name (Legal Business Name): MATTHEW JOHN KRINISKE MPH, OTR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2008
Last Update Date: 11/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 OVERBROOK DR
MILLWOOD NY
10546-1033
US

IV. Provider business mailing address

28 OVERBROOK DR
MILLWOOD NY
10546-1033
US

V. Phone/Fax

Practice location:
  • Phone: 914-882-2124
  • Fax:
Mailing address:
  • Phone: 914-882-2124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number007604-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: