Provider Demographics
NPI:1508800491
Name:ROBILLARD, KRISTEN SCHENK (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:SCHENK
Last Name:ROBILLARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4855 CAMP ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075
Mailing Address - Country:US
Mailing Address - Phone:716-646-1084
Mailing Address - Fax:716-646-0786
Practice Address - Street 1:4855 CAMP ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075
Practice Address - Country:US
Practice Address - Phone:716-646-1084
Practice Address - Fax:716-646-0786
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211538207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02273036Medicaid
NY396533OtherWELLCARE
NY396533OtherWELLCARE
NY02273036Medicaid
NYCC8390Medicare PIN
DD8671Medicare PIN
NYP00256765Medicare PIN