Provider Demographics
NPI:1215808233
Name:RIELLY, KRISTEN ANN (CEP)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:ANN
Last Name:RIELLY
Suffix:
Gender:F
Credentials:CEP
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Mailing Address - Street 1:40 BROOKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:PLANDOME
Mailing Address - State:NY
Mailing Address - Zip Code:11030-1405
Mailing Address - Country:US
Mailing Address - Phone:917-745-5432
Mailing Address - Fax:516-627-1356
Practice Address - Street 1:40 BROOKSIDE DR
Practice Address - Street 2:
Practice Address - City:PLANDOME
Practice Address - State:NY
Practice Address - Zip Code:11030-1405
Practice Address - Country:US
Practice Address - Phone:917-745-5432
Practice Address - Fax:516-627-1356
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-15
Last Update Date:2025-09-15
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist