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General NPI Number Information
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NPI Number | 1467018010
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Entity Type | Individual
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Provider Name | KELLY KRIVIT
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Gender | Female
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Dates
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Enumeration Date | 05/18/2019
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Last Update Date | 05/18/2019
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Provider Practice Location Address
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Address Line | 299 HALLOCK AVE
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City | PORT JEFFERSON STATION
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State | NY
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Zip | 11776-1217
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Country | US
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Telephone | 631-331-2204
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Fax |
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Provider Business Mailing Address
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Address Line | 277 HARRISON AVE
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City | MILLER PLACE
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State | NY
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Zip | 11764-3429
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Country | US
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Telephone | 631-312-4249
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | NY
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