Healthcare Provider Details

I. General information

NPI: 1346501582
Provider Name (Legal Business Name): KRISTIN MARIE ENGELSTAD M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2012
Last Update Date: 06/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 W 168TH ST COLUMBIA UNIVERSITY P&S 4-423
NEW YORK NY
10032-3725
US

IV. Provider business mailing address

630 W 168TH ST COLULMBIA UNIVERSITY P&S 4-423
NEW YORK NY
10032-3725
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-6834
  • Fax:
Mailing address:
  • Phone: 212-305-6834
  • Fax: 212-342-2893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: