Individual
KRISTINA PHILIPPEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
538 BROADHOLLOW RD, SUITE 202, MELVILLE, NY 11747-3676
(631) 385-7780
Mailing address
139 COMMONWEALTH AVE, MASSAPEQUA, NY 11758-4142
(516) 451-0771
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
801263131
NY
252Y00000X
Early Intervention Provider Agency
Primary
801182131
NY
Other
Enumeration date
03/18/2015
Last updated
03/18/2015
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