Provider Demographics
NPI:1144391889
Name:ROBILLARD, KRISTEN E (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:E
Last Name:ROBILLARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ENDICOTT
Mailing Address - State:NY
Mailing Address - Zip Code:13760-4925
Mailing Address - Country:US
Mailing Address - Phone:607-785-2460
Mailing Address - Fax:607-785-2584
Practice Address - Street 1:415 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ENDICOTT
Practice Address - State:NY
Practice Address - Zip Code:13760-4925
Practice Address - Country:US
Practice Address - Phone:607-785-2460
Practice Address - Fax:607-785-2584
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY193513207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01560609Medicaid
G93824Medicare UPIN
NY56210CMedicare PIN