Healthcare Provider Details

I. General information

NPI: 1417863812
Provider Name (Legal Business Name): MRS. KRISTIN TARSILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 5TH AVE # 501
NEW YORK NY
10065-7216
US

IV. Provider business mailing address

326 HOLDRIDGE AVE
STATEN ISLAND NY
10312-6031
US

V. Phone/Fax

Practice location:
  • Phone: 212-223-3632
  • Fax:
Mailing address:
  • Phone: 917-734-7458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number017735-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: