Provider Demographics
NPI:1942454954
Name:MENEGIO, KRISTIN (COTA/L)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:MENEGIO
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 230
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12037-0230
Mailing Address - Country:US
Mailing Address - Phone:518-821-2186
Mailing Address - Fax:518-477-6074
Practice Address - Street 1:2500 POND VW
Practice Address - Street 2:SUITE 102A
Practice Address - City:CASTLETON
Practice Address - State:NY
Practice Address - Zip Code:12033-9750
Practice Address - Country:US
Practice Address - Phone:518-477-6072
Practice Address - Fax:518-477-6074
Is Sole Proprietor?:No
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001805-12083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine