Healthcare Provider Details

I. General information

NPI: 1891778270
Provider Name (Legal Business Name): KATHRYN KIRPAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 03/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 SEGUINE AVE SUITE 1
STATEN ISLAND NY
10309-3709
US

IV. Provider business mailing address

305 SEGUINE AVE SUITE 1
STATEN ISLAND NY
10309-3709
US

V. Phone/Fax

Practice location:
  • Phone: 718-967-8300
  • Fax: 718-967-8335
Mailing address:
  • Phone: 718-967-8300
  • Fax: 718-967-8335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number161916
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: