Healthcare Provider Details

I. General information

NPI: 1982357265
Provider Name (Legal Business Name): KRISTIN REBECCA POPTEAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2022
Last Update Date: 01/27/2022
Certification Date: 01/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 OLD COUNTRY RD STE 200
PLAINVIEW NY
11803-4934
US

IV. Provider business mailing address

2944 212TH ST
BAYSIDE NY
11360-2531
US

V. Phone/Fax

Practice location:
  • Phone: 516-931-5552
  • Fax:
Mailing address:
  • Phone: 917-533-3393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number003025
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: