Provider Demographics
NPI:1114445418
Name:PRINCIOTTA, KRISTIN RAE
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:RAE
Last Name:PRINCIOTTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 DERRI CT
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-5873
Mailing Address - Country:US
Mailing Address - Phone:631-219-6653
Mailing Address - Fax:
Practice Address - Street 1:500 ENDO BLVD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-4899
Practice Address - Country:US
Practice Address - Phone:516-876-5047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-07
Last Update Date:2017-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist