Provider Demographics
NPI:1477591329
Name:ARCHER, KRISTA AMMIRATI (DPM)
Entity Type:Individual
Prefix:DR
First Name:KRISTA
Middle Name:AMMIRATI
Last Name:ARCHER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 WASHINGTON ST
Mailing Address - Street 2:12L
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-1442
Mailing Address - Country:US
Mailing Address - Phone:646-436-3746
Mailing Address - Fax:
Practice Address - Street 1:61 E 66TH ST
Practice Address - Street 2:GROUND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6114
Practice Address - Country:US
Practice Address - Phone:646-912-4456
Practice Address - Fax:212-452-0226
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00282900213ES0103X
NYN006080213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1285726331OtherNPI-ORGANIZATION
NY103625Medicare PIN