Individual
CHRIS J KIELBASA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
232 4TH AVE, GREENPORT, NY 11944-1526
(631) 477-0070
(631) 477-8983
Mailing address
232 4TH AVE, GREENPORT, NY 11944-1526
(631) 477-0070
(631) 477-8983
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
214789
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20823825
—
NY
Enumeration date
05/05/2006
Last updated
02/24/2021
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