KRISTIN L MACK (NPI# 1447539507) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1447539507 |
| Entity Type | Individual |
| Full Name | KRISTIN L MACK |
| Other Name | KRISTIN MICHELLE LAKE |
| Credential | DO |
| Practice Address |
102 Race Track Rd Ste 1 Ticonderoga NY 12883 |
| Mailing Address |
9 Carey Rd Queensbury NY 12804-7880 |
| Practice Telephone | 5185856708 |
| Practice Fax Number | 5185853260 |
| Mailing Telephone | 5187610300 |
| Mailing Fax Number | 5188242388 |
| Enumeration Date | 2011-08-08 |
| Last Update Date | 2019-06-19 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 272786 | NY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | 03861103 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1772 Helderberg Trl, Berne, NY 120232709 | 5188729262 | 5188729265 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821623679 | Kristin Taylor Mack | Student in an Organized Health Care Education/Training Program | 229 North Main Street, Smyrna, DE 19977 | 2020-03-11 |
| Street Address |
102 RACE TRACK RD STE 1 |
| City | TICONDEROGA |
| State | NY |
| Zip Code | 12883 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649295254 | Ephraim E Back | Family Medicine | 102 Race Track Rd Ste 1, Ticonderoga, NY 12883 | 2006-07-13 |
| 1184285751 | Nicholas J Montello | Nurse Practitioner | 102 Race Track Rd Ste 1, Ticonderoga, NY 12883-4004 | 2019-06-25 |
| 1669032470 | Elizabeth Anderson | Nurse Practitioner | 102 Race Track Rd Ste 1, Ticonderoga, NY 12883-4004 | 2019-06-14 |
| 1770068371 | Loren M Allen | Nurse Practitioner | 102 Race Track Rd Ste 1, Ticonderoga, NY 12883-4004 | 2018-09-28 |
| 1992229595 | Janine N Gadjo | Nurse Practitioner | 102 Race Track Rd Ste 1, Ticonderoga, NY 12883-4004 | 2017-07-26 |
| 1356871909 | Nicole Robinson | Pediatrics | 102 Race Track Rd Ste 1, Ticonderoga, NY 12883-4004 | 2017-06-15 |
| 1952449829 | Dennis S O'brien | Internal Medicine | 102 Race Track Rd Ste 1, Ticonderoga, NY 12883-4004 | 2007-02-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528582822 | Walgreen Co | Pharmacy | 1161 Nys Route 9n, Ticonderoga, NY 12883 | 2017-07-28 |
| 1891233540 | Anne Kuhl | Specialist | 70 Lake George Ave, Ticonderoga, NY 12883 | 2017-02-02 |
| 1336697580 | Hayley Jean Woods | Pharmacist | 1161 Nys Rte 9n, Ticonderoga, NY 12883 | 2016-09-16 |
| 1962776153 | Linda L Leavens | Counselor | 166 Lord Howe St., Ticonderoga, NY 12883 | 2012-03-06 |
| 1093958084 | Diana J Eisenberg | Skilled Nursing Facility | 340 Burgoyne Road, Ticonderoga, NY 12883 | 2009-04-07 |
| 1386765881 | Dean Lewis Cook | Dentist | 3 Defiance St, Ticonderoga, NY 12883 | 2007-04-02 |
| 1902936941 | Susan B Malaney | Counselor | 5 Defiance Street, Ticonderoga, NY 12883 | 2007-03-07 |
| 1023182813 | Moses Ludington Hospital Pharmacy | Pharmacy | 1019 Wicker Street, Ticonderoga, NY 12883 | 2006-11-20 |
| 1336245083 | Ticonderoga Emergency Squad Inc | Ambulance | 118 Champlain Avenue, Ticonderoga, NY 12883 | 2006-09-16 |
| 1952319386 | Hudson Headwaters Health Network | Social Worker | 101 Adirondack Drive, Suite 2, Ticonderoga, NY 12883 | 2006-08-03 |
| Find all providers in zip 12883 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649295254 | Ephraim E Back | Family Medicine | 102 Race Track Rd Ste 1, Ticonderoga, NY 12883 | 2006-07-13 |
| 1972907749 | Hudson Headwaters Health Network | Family Medicine | 1019 Wicker St, Ticonderoga, NY 12883-1039 | 2014-10-22 |
| 1255595641 | Kathleen P Huestis | Family Medicine | 102 Race Track Rd, Ticonderoga, NY 12883-4004 | 2008-07-15 |
| 1639183213 | Richard N Mckeever | Family Medicine | 102 Race Track Rd, Suite 1, Ticonderoga, NY 12883-4004 | 2006-07-28 |
| 1073527727 | Glen D Chapman | Family Medicine | 102 Race Track Rd, Suite 1, Ticonderoga, NY 12883-4004 | 2006-07-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881295558 | Mamoon Malik | Family Medicine | 90 Menands Rd, Albany, NY 12204-1400 | 2020-11-08 |
| 1336749571 | Chowdhury Medical PC | Family Medicine | 155 Alkier St, Brentwood, NY 11717-5129 | 2020-10-27 |
| 1356940084 | Rebecca Jean Smouse | Family Medicine | 1107 Prendergast Ave, Jamestown, NY 14701-3315 | 2020-10-23 |
| 1336748136 | Rapha House Calls | Family Medicine | 2 Fernglade Ct, Chester, NY 10918-2637 | 2020-10-22 |
| 1174122980 | Richmond Health Partners Ipa LLC | Family Medicine | 1161 Victory Blvd, Staten Island, NY 10301-3621 | 2020-10-22 |
| 1730787128 | Michael C Secallus | Family Medicine | 66 Kirkwood Gdns, Kirkwood, NY 13795-1623 | 2020-10-16 |
| 1861099053 | Julia Gross Family Health Nurse Practitioner, Pllc | Family Medicine | 950 Route 146 Ste 100, Clifton Park, NY 12065-3667 | 2020-10-01 |
| 1013523190 | Steinway Hope Medical LLC | Family Medicine | 8829 54th Ave Fl 2, Elmhurst, NY 11373-4543 | 2020-09-23 |
| 1538774500 | Jenny Brandt | Family Medicine | 3048 Sunset Ln # 2, Schenectady, NY 12303-5528 | 2020-09-15 |
| 1992319016 | Sarah Glaser | Family Medicine | 30 W 24th St, New York, NY 10010-3207 | 2020-09-04 |
| Find all providers with the same taxonomy | ||||
| City | TICONDEROGA |
| Zip Code | 12883 |
Please comment or provide details below to improve the information on KRISTIN L MACK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.