Provider Demographics
NPI:1417668773
Name:GAETANO, KRISTA M
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:M
Last Name:GAETANO
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:PO BOX 376
Mailing Address - Street 2:
Mailing Address - City:CROMPOND
Mailing Address - State:NY
Mailing Address - Zip Code:10517-0376
Mailing Address - Country:US
Mailing Address - Phone:914-673-2342
Mailing Address - Fax:
Practice Address - Street 1:519 UNION AVE
Practice Address - Street 2:
Practice Address - City:PEEKSKILL
Practice Address - State:NY
Practice Address - Zip Code:10566-4706
Practice Address - Country:US
Practice Address - Phone:646-799-6312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY05592425343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05592425Medicaid