Provider Demographics
NPI:1245864271
Name:KREIDER, MAUREEN (NP)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:KREIDER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 E 14TH ST APT 2G
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-2903
Mailing Address - Country:US
Mailing Address - Phone:917-301-4122
Mailing Address - Fax:
Practice Address - Street 1:4 IRVING PLACE
Practice Address - Street 2:CON EDISON EMPLOYEE WELLNESS CENTER
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003
Practice Address - Country:US
Practice Address - Phone:212-780-2969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-28
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY385492363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health