Provider Demographics
NPI:1255681946
Name:CONNELLY, CRISTIN
Entity Type:Individual
Prefix:MS
First Name:CRISTIN
Middle Name:
Last Name:CONNELLY
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 1:82 MOUNT HOPE BLVD
Mailing Address - Street 2:
Mailing Address - City:HASTINGS ON HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:10706-2411
Mailing Address - Country:US
Mailing Address - Phone:914-761-0600
Mailing Address - Fax:914-949-6778
Practice Address - Street 1:141 N CENTRAL AVE
Practice Address - Street 2:C/O WJCS
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530-1912
Practice Address - Country:US
Practice Address - Phone:914-761-0600
Practice Address - Fax:914-949-6778
Is Sole Proprietor?:No
Enumeration Date:2012-09-11
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program