Provider Demographics
NPI:1659635068
Name:POLIDORI, KRISTIN (MS SPED)
Entity Type:Individual
Prefix:MISS
First Name:KRISTIN
Middle Name:
Last Name:POLIDORI
Suffix:
Gender:F
Credentials:MS SPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:297 DUTCHMANS POINT RD
Mailing Address - Street 2:
Mailing Address - City:MANTOLOKING
Mailing Address - State:NJ
Mailing Address - Zip Code:08738-1009
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:297 DUTCHMANS POINT RD
Practice Address - Street 2:
Practice Address - City:MANTOLOKING
Practice Address - State:NJ
Practice Address - Zip Code:08738-1009
Practice Address - Country:US
Practice Address - Phone:917-797-3573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-29
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2177400172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker