Provider Demographics
NPI:1639323660
Name:KRINISKE, MATTHEW JOHN (MPH, OTR)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JOHN
Last Name:KRINISKE
Suffix:
Gender:M
Credentials:MPH, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 OVERBROOK DR
Mailing Address - Street 2:
Mailing Address - City:MILLWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:10546-1033
Mailing Address - Country:US
Mailing Address - Phone:914-882-2124
Mailing Address - Fax:
Practice Address - Street 1:28 OVERBROOK DR
Practice Address - Street 2:
Practice Address - City:MILLWOOD
Practice Address - State:NY
Practice Address - Zip Code:10546-1033
Practice Address - Country:US
Practice Address - Phone:914-882-2124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007604-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics