Provider Demographics
NPI:1346740990
Name:KERSTEN, THERESE ANNE
Entity Type:Individual
Prefix:
First Name:THERESE
Middle Name:ANNE
Last Name:KERSTEN
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 1:24849 88TH RD
Mailing Address - Street 2:
Mailing Address - City:BELLEROSE
Mailing Address - State:NY
Mailing Address - Zip Code:11426-2005
Mailing Address - Country:US
Mailing Address - Phone:347-229-2069
Mailing Address - Fax:
Practice Address - Street 1:24849 88TH RD
Practice Address - Street 2:
Practice Address - City:BELLEROSE
Practice Address - State:NY
Practice Address - Zip Code:11426-2005
Practice Address - Country:US
Practice Address - Phone:347-229-2069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist