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General NPI Number Information
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NPI Number | 1548050800
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Entity Type | Individual
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Provider Name | KRISTOPHER KONYAK
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Gender | Male
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Dates
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Enumeration Date | 05/09/2025
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Last Update Date | 05/09/2025
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Provider Practice Location Address
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Address Line | 323 N TIOGA ST
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City | ITHACA
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State | NY
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Zip | 14850-4205
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Country | US
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Telephone | 607-936-1771
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Fax | 607-229-1200
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Provider Business Mailing Address
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Address Line | 33 DENISON PKWY W
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City | CORNING
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State | NY
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Zip | 14830-2613
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Country | US
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Telephone | 607-937-3200
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Fax | 607-937-3205
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 126470
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License Number State | NY
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