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NPI Code Detail

MEDICARE: KRISTEN GANCHROW

MEDICARE: KRISTEN GANCHROW
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
1225100000XPhysical Therapist028991NY

General Provider Information

NPI Number : 1710207766
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTEN GANCHROW
Provider Business Mailing Address
First Line : 7161 159TH ST
Second Line :
City : FLUSHING
State : NY
Zip : 11365-4123
Country : US
Telephone Number : 718-303-8323
Fax Number :
Provider Business Practice Location Address
First Line : 7161 159TH ST
Second Line :
City : FLUSHING
State : NY
Zip : 11365-4123
Country : US
Telephone Number : 718-303-8323
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2010
Last Update Date : 06/01/2010

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Directions to “ KRISTEN GANCHROW ” Practice Location

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