Provider Demographics
NPI:1063774495
Name:BRECKENRIDGE SCHURR, KRISTY B
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:B
Last Name:BRECKENRIDGE SCHURR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRISTY
Other - Middle Name:
Other - Last Name:SCHURR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:7 OAK AVE
Mailing Address - Street 2:2
Mailing Address - City:TUCKAHOE
Mailing Address - State:NY
Mailing Address - Zip Code:10707-4005
Mailing Address - Country:US
Mailing Address - Phone:914-216-4297
Mailing Address - Fax:
Practice Address - Street 1:7 OAK AVENUE
Practice Address - Street 2:2
Practice Address - City:TUCKAHOE
Practice Address - State:NY
Practice Address - Zip Code:10707
Practice Address - Country:US
Practice Address - Phone:914-216-4297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1116188252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency