Provider Demographics
NPI:1215293709
Name:DR. FRED KRELLENSTEIN, PSYCHOLOGIST, P.C.
Entity type:Organization
Organization Name:DR. FRED KRELLENSTEIN, PSYCHOLOGIST, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:
Authorized Official - Last Name:KRELLENSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-921-3943
Mailing Address - Street 1:8 HOLLY DR
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-5718
Mailing Address - Country:US
Mailing Address - Phone:516-921-3943
Mailing Address - Fax:516-682-8210
Practice Address - Street 1:8 HOLLY DR
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-5718
Practice Address - Country:US
Practice Address - Phone:516-921-3943
Practice Address - Fax:516-682-8210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-09
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00872835Medicaid
NY00872835Medicaid