Provider Demographics
NPI:1790930014
Name:HERBST, KRISTEN A (DO)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:A
Last Name:HERBST
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ASSOCIATE DR
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820-2266
Mailing Address - Country:US
Mailing Address - Phone:607-433-6314
Mailing Address - Fax:607-433-6331
Practice Address - Street 1:1 ASSOCIATE DR
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-2266
Practice Address - Country:US
Practice Address - Phone:607-433-6314
Practice Address - Fax:607-433-6331
Is Sole Proprietor?:No
Enumeration Date:2008-12-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB0947900207X00000X
NY291079207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0427721Medicaid
NJ403292Medicare PIN