Individual
KRISTEN JATA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
47 JOHN ST, PLAINVIEW, NY 11803-2803
(516) 732-9847
Mailing address
47 JOHN ST, PLAINVIEW, NY 11803-2803
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
020886
NY
Other
Enumeration date
09/21/2016
Last updated
09/21/2016
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