MEDICARE: KRISTIN GILLESPIE

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	251300000X	Local Education Agency (LEA)

General Provider Information

NPI Number	:	1821430018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN GILLESPIE

Provider Business Mailing Address
First Line	:	513 SHORE RD
Second Line	:
City	:	LONG BEACH
State	:	NY
Zip	:	11561-4538
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	513 SHORE RD
Second Line	:
City	:	LONG BEACH
State	:	NY
Zip	:	11561-4538
Country	:	US
Telephone Number	:	516-305-0974
Fax Number	:

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

Provider Enumeration Date	:	07/29/2013
Last Update Date	:	07/29/2013

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Directions to “ KRISTIN GILLESPIE ” Practice Location

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