Provider Demographics
NPI:1972167823
Name:ALFANO, KRISTEN DIANNE
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:DIANNE
Last Name:ALFANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 UNDERHILL AVE APT 1A
Mailing Address - Street 2:
Mailing Address - City:WEST HARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10604-2441
Mailing Address - Country:US
Mailing Address - Phone:914-879-7216
Mailing Address - Fax:
Practice Address - Street 1:1133 WESTCHESTER AVE STE N230
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10604-3516
Practice Address - Country:US
Practice Address - Phone:914-576-5292
Practice Address - Fax:914-470-0406
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-25
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY708553131174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist