Provider Demographics
NPI:1891778270
Name:KIRPAN, KATHRYN (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:
Last Name:KIRPAN
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 1:305 SEGUINE AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-3709
Mailing Address - Country:US
Mailing Address - Phone:718-967-8300
Mailing Address - Fax:718-967-8335
Practice Address - Street 1:305 SEGUINE AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-3709
Practice Address - Country:US
Practice Address - Phone:718-967-8300
Practice Address - Fax:718-967-8335
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY161916207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02087387Medicaid
NYH25061Medicare UPIN
NY65C11HW681Medicare PIN
NY65C111Medicare ID - Type Unspecified