Healthcare Provider Details

I. General information

NPI: 1821022971
Provider Name (Legal Business Name): TERESA DEBARTOLO KRAMER ANP C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HSC T17-040 NICOLLS ROAD
STONY BROOK NY
11794
US

IV. Provider business mailing address

87 MT SINAI AVE
MT SINAI NY
11766
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-1556
  • Fax: 631-444-1618
Mailing address:
  • Phone: 631-928-0547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF3023361
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: