Provider Demographics
NPI:1316298375
Name:CRONIN, KATHARINE HAXALL (MS, MPH, CPNP)
Entity type:Individual
Prefix:MRS
First Name:KATHARINE
Middle Name:HAXALL
Last Name:CRONIN
Suffix:
Gender:F
Credentials:MS, MPH, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 2ND PL
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-6118
Mailing Address - Country:US
Mailing Address - Phone:202-302-5000
Mailing Address - Fax:
Practice Address - Street 1:1111 MONTAUK HWY
Practice Address - Street 2:SUITE 104
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4910
Practice Address - Country:US
Practice Address - Phone:631-661-2510
Practice Address - Fax:631-669-6502
Is Sole Proprietor?:No
Enumeration Date:2012-09-30
Last Update Date:2014-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6435541163W00000X
NY382344363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse