Provider Demographics
NPI:1427714245
Name:TABOR, KRISTEN (BA)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:TABOR
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:T
Other - Last Name:KRAMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1795 HUDSON AVE APT 203
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-5159
Mailing Address - Country:US
Mailing Address - Phone:585-261-7087
Mailing Address - Fax:
Practice Address - Street 1:1099 JAY ST BLDG P
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14611-1164
Practice Address - Country:US
Practice Address - Phone:585-865-1550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist