Healthcare Provider Details

I. General information

NPI: 1558808378
Provider Name (Legal Business Name): KRISTIN O'CONNOR PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2017
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 NORTH ST STE 401
WHITE PLAINS NY
10605-2232
US

IV. Provider business mailing address

1 HOSPITAL PLZ
STAMFORD CT
06902-3602
US

V. Phone/Fax

Practice location:
  • Phone: 763-797-2146
  • Fax:
Mailing address:
  • Phone: 203-276-7298
  • Fax: 203-276-4282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3768
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number031196
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: