Provider Demographics
NPI:1104802081
Name:JANSON, KRISTIN ELISA (DPM)
Entity type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:ELISA
Last Name:JANSON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 MADISON AVE RM 802
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-0020
Mailing Address - Country:US
Mailing Address - Phone:212-689-9388
Mailing Address - Fax:212-689-0195
Practice Address - Street 1:185 MADISON AVE RM 802
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-0020
Practice Address - Country:US
Practice Address - Phone:212-689-9388
Practice Address - Fax:212-689-0195
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-21
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004687213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP56492OtherMEDICARE PTAN
NY5590480001Medicare NSC