Individual
KRISTIN ROSE MCDONOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
55 E OLD COUNTRY RD, HICKSVILLE, NY 11801-4293
(169) 876-4285
Mailing address
1 ATLANTIC AVE APT 78, FARMINGDALE, NY 11735-2772
(631) 560-5861
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
026791
NY
363AS0400X
Surgical Physician Assistant
026791
NY
Other
Enumeration date
07/15/2021
Last updated
11/10/2023
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