Provider Demographics
NPI:1609203223
Name:KREMBERG, JOHANNA (DVM)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:
Last Name:KREMBERG
Suffix:
Gender:F
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 HUNNS LAKE PT
Mailing Address - Street 2:
Mailing Address - City:STANFORDVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12581-5946
Mailing Address - Country:US
Mailing Address - Phone:845-475-4602
Mailing Address - Fax:
Practice Address - Street 1:109 N MABBETTSVILLE RD
Practice Address - Street 2:
Practice Address - City:MILLBROOK
Practice Address - State:NY
Practice Address - Zip Code:12545-5356
Practice Address - Country:US
Practice Address - Phone:845-677-5500
Practice Address - Fax:845-677-6009
Is Sole Proprietor?:No
Enumeration Date:2013-09-27
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012108174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian