Provider Demographics
NPI:1609805035
Name:CRONIN, KERRY A (MD)
Entity Type:Individual
Prefix:DR
First Name:KERRY
Middle Name:A
Last Name:CRONIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 W JERICHO TPKE
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2619
Mailing Address - Country:US
Mailing Address - Phone:631-360-5900
Mailing Address - Fax:
Practice Address - Street 1:4724 NESCONSET HWY
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-2580
Practice Address - Country:US
Practice Address - Phone:631-474-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY227966207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02411663Medicaid
NY7196554OtherAETNA
NYH99756Medicare UPIN
NY7196554OtherAETNA