MEDICARE: KRYSTINA LEPORE

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
1	122300000X	Dentist	DN20075	FL
2	390200000X	Student in an Organized Health Care Education/Training Program

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164781761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRYSTINA LEPORE

Provider Business Mailing Address
First Line	:	515 W 59TH ST APT 29B
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10019-1042
Country	:	US
Telephone Number	:	954-290-7623
Fax Number	:

Provider Business Practice Location Address
First Line	:	2091 COLLIER PKWY
Second Line	:
City	:	LAND O LAKES
State	:	FL
Zip	:	34639-5202
Country	:	US
Telephone Number	:	954-290-7623
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2012
Last Update Date	:	05/20/2013

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