Provider Demographics
NPI:1285677922
Name:KIRSTEIN, LAURIE JILL (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:JILL
Last Name:KIRSTEIN
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 1:300 E 66TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-6800
Mailing Address - Country:US
Mailing Address - Phone:646-888-5206
Mailing Address - Fax:646-888-4921
Practice Address - Street 1:300 E 66TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6800
Practice Address - Country:US
Practice Address - Phone:646-888-5206
Practice Address - Fax:646-888-4921
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA227808208600000X
NJ25MA082403002086X0206X
NY250647208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0154687Medicaid
NJ226217P3VMedicare PIN