Healthcare Provider Details

I. General information

NPI: 1255571451
Provider Name (Legal Business Name): KRYSTEN ANNE RAYMOND RPA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2009
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 GLEN COVE AVE
SEA CLIFF NY
11579-1455
US

IV. Provider business mailing address

207 GLEN COVE AVE
SEA CLIFF NY
11579-1455
US

V. Phone/Fax

Practice location:
  • Phone: 516-676-1742
  • Fax: 516-676-9662
Mailing address:
  • Phone: 516-676-1742
  • Fax: 516-676-9662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number012589
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: