Provider Demographics
NPI:1912310251
Name:FALLON, KRISTEN MARY
Entity Type:Individual
Prefix:MISS
First Name:KRISTEN
Middle Name:MARY
Last Name:FALLON
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 1:21 LONDON TER
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-4036
Mailing Address - Country:US
Mailing Address - Phone:845-323-0234
Mailing Address - Fax:
Practice Address - Street 1:21 LONDON TER
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-4036
Practice Address - Country:US
Practice Address - Phone:845-323-0234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-04
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program