Healthcare Provider Details

I. General information

NPI: 1588642060
Provider Name (Legal Business Name): KERRI ANN LEE MSGC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GUSTAVE L LEVY PL MOUNT SINAI MEDICAL CENTER BX 1201
NEW YORK NY
10029-6500
US

IV. Provider business mailing address

322 HACKENSACK ST
WOOD RIDGE NJ
07075-1317
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-6012
  • Fax:
Mailing address:
  • Phone: 201-421-6640
  • Fax:

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: