Provider Demographics
NPI:1417258880
Name:KRIST, CORINNE PATRICIA (DO)
Entity Type:Individual
Prefix:DR
First Name:CORINNE
Middle Name:PATRICIA
Last Name:KRIST
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MISS
Other - First Name:CORINNE
Other - Middle Name:PATRICIA
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:78 NORWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-4417
Mailing Address - Country:US
Mailing Address - Phone:716-515-8078
Mailing Address - Fax:
Practice Address - Street 1:1510 ROUTE 438
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:NY
Practice Address - Zip Code:14081-9502
Practice Address - Country:US
Practice Address - Phone:716-532-5582
Practice Address - Fax:716-532-0110
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-16
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY262755207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics