Provider Demographics
NPI:1295977734
Name:CONFORTI, KRISTIN DIANE (DPT)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:DIANE
Last Name:CONFORTI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 E GATE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-2136
Mailing Address - Country:US
Mailing Address - Phone:516-227-5344
Mailing Address - Fax:516-908-6222
Practice Address - Street 1:825 E GATE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-2136
Practice Address - Country:US
Practice Address - Phone:516-227-5344
Practice Address - Fax:516-908-6222
Is Sole Proprietor?:No
Enumeration Date:2009-03-30
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030587225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400028264Medicare PIN