Healthcare Provider Details

I. General information

NPI: 1922530542
Provider Name (Legal Business Name): KRISTEN DE VRIES DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2017
Last Update Date: 07/28/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E 68TH ST # F-1600
NEW YORK NY
10065-4870
US

IV. Provider business mailing address

1400 PELHAM PKWY S
BRONX NY
10461-1138
US

V. Phone/Fax

Practice location:
  • Phone: 212-746-1500
  • Fax: 212-746-8303
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number310560-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: