Doctor Name: | CRISTIN ROSE GENGLER |
NPI Number: | 1073885604 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CPNP |
License Number: | 382249 |
Business Practice Address: | 4 Technology Dr East Setauket, NY - 117334080 |
Business Phone Number: | 6314442700 |
Business Fax Number: | |
Mailing Address: | Po Box 1559, STONY BROOK |
State: | NY |
Postal Code: | 117900989 |
Phone Number: | 6314440650 |
Fax Number: | |
NPI Enumeration Date: | 01/27/2012 |
NPI Last Update Date: | 07/05/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LP0200X |
License Number: | 382249 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Pediatrics |
Taxonomy Definition: |