Provider Demographics
NPI:1649894197
Name:KORZEVINSKI, KRISTEN MARGARET
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:MARGARET
Last Name:KORZEVINSKI
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 1:156 LAWRENCE ST
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-2042
Mailing Address - Country:US
Mailing Address - Phone:516-761-3832
Mailing Address - Fax:
Practice Address - Street 1:2300 WESTCHESTER AVE STE 304
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-5072
Practice Address - Country:US
Practice Address - Phone:718-409-1450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-01
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist