MEDICARE: ANGELA KRISTAN

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	207Q00000X	Family Medicine Physician	287999	NY
2	208M00000X	Hospitalist Physician	287999	NY

General Provider Information

NPI Number	:	1518386226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA KRISTAN

Provider Business Mailing Address
First Line	:	1141 E UNION ST # 9201
Second Line	:
City	:	NEWARK
State	:	NY
Zip	:	14513-9201
Country	:	US
Telephone Number	:	585-310-8787
Fax Number	:

Provider Business Practice Location Address
First Line	:	1880 E RIDGE RD STE 8
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14622-2450
Country	:	US
Telephone Number	:	585-363-5040
Fax Number	:

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

Provider Enumeration Date	:	04/09/2014
Last Update Date	:	02/26/2025

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Directions to “ ANGELA KRISTAN ” Practice Location

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