Provider Demographics
NPI:1508010190
Name:CHOI, KRISTEN (MA)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:CHOI
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22315 57TH AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-2041
Mailing Address - Country:US
Mailing Address - Phone:917-749-9610
Mailing Address - Fax:718-229-4034
Practice Address - Street 1:22315 57TH AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11364-2041
Practice Address - Country:US
Practice Address - Phone:917-749-9610
Practice Address - Fax:718-229-4034
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-09
Last Update Date:2008-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012814235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist