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NPI Code Detail

MEDICARE: KAYLA CRISCENZO

MEDICARE: KAYLA CRISCENZO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
22255A2300XAthletic Trainer

General Provider Information

NPI Number : 1023574902
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAYLA CRISCENZO
Provider Business Mailing Address
First Line : 275 MOUNT CARMEL AVENUE
Second Line : CAMPUS BOX #5236
City : HAMDEN
State : CT
Zip : 06518
Country : US
Telephone Number : 201-270-8323
Fax Number :
Provider Business Practice Location Address
First Line : 275 MOUNT CARMEL AVE
Second Line :
City : HAMDEN
State : CT
Zip : 06518-1908
Country : US
Telephone Number : 201-270-8323
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/14/2019
Last Update Date : 02/14/2019

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Directions to “ KAYLA CRISCENZO ” Practice Location

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