Provider Demographics
NPI:1548797509
Name:DICE, KRISTY (CF-SLO)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:
Last Name:DICE
Suffix:
Gender:F
Credentials:CF-SLO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6910 59TH DR
Mailing Address - Street 2:
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-2918
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8866 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385-7857
Practice Address - Country:US
Practice Address - Phone:718-850-0400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-21
Last Update Date:2017-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program