Provider Demographics
NPI:1730686486
Name:CRESPO, KIRSTIE M (NP)
Entity type:Individual
Prefix:
First Name:KIRSTIE
Middle Name:M
Last Name:CRESPO
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 1:3050 CORLEAR AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-5181
Mailing Address - Country:US
Mailing Address - Phone:718-543-2700
Mailing Address - Fax:718-601-0965
Practice Address - Street 1:216 CONGERS RD BLDG 3
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-6261
Practice Address - Country:US
Practice Address - Phone:845-480-6678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-10
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY342845363LF0000X
NYF404779363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily