Individual
KRISTEN DISMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
625 BELLE TERRE RD STE 202, PORT JEFFERSON, NY 11777-2318
(631) 686-7990
Mailing address
4 HAZELWOOD AVE APT 1, WESTHAMPTON BEACH, NY 11978-1405
(631) 445-1147
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
025086
NY
Other
Enumeration date
09/17/2020
Last updated
09/17/2020
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