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General NPI Number Information
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NPI Number | 1215293709
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Entity Type | Organization
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Legal Business Name | DR. FRED KRELLENSTEIN, PSYCHOLOGIST, P.C.
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Dates
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Enumeration Date | 04/09/2012
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Last Update Date | 07/17/2013
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Provider Practice Location Address
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Address Line | 8 HOLLY DR
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City | SYOSSET
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State | NY
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Zip | 11791-5718
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Country | US
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Telephone | 516-921-3943
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Fax | 516-682-8210
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Provider Business Mailing Address
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Address Line | 8 HOLLY DR
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City | SYOSSET
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State | NY
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Zip | 11791-5718
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Country | US
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Telephone | 516-921-3943
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Fax | 516-682-8210
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. FRED KRELLENSTEIN
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Credential |
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Telephone | 516-921-3943
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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