Provider Demographics
NPI:1356008536
Name:KRISPIN, NATHANIEL (PA-C)
Entity Type:Individual
Prefix:MR
First Name:NATHANIEL
Middle Name:
Last Name:KRISPIN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3721 CARREL BLVD
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-5911
Mailing Address - Country:US
Mailing Address - Phone:516-209-7685
Mailing Address - Fax:
Practice Address - Street 1:13020 FARMERS BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-4122
Practice Address - Country:US
Practice Address - Phone:646-518-8263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-22
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant