Individual provider Active NPI

Kristin Magnuson Nord, M.D.

  • Dermatology Physician
  • New York, NY
National Provider Identifier
1043337801
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
233383 Issued in NY
Practice address
161 Fort Washington Ave
12TH Floor, Room 1206a
New York, NY 10032-3729
Phone
(212) 305-5317
Fax
(212) 795-1859
NPI assigned
Mar 24, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 233383 NY Primary

Addresses

Primary practice location

161 Fort Washington Ave
12TH Floor, Room 1206a
New York, NY 10032-3729

Mailing address

30 Waterside PLZ
Apt. 25E
New York, NY 10010-2622
Phone (212) 684-4409

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150603000203 CA Order and Referring Only - DermatologyPractitioner - Dermatology 3072794940

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
233383NYMDDermatology Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1043337801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 WATERSIDE PLZ",
            "address_2": "APT. 25E",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100102622",
            "telephone_number": "212-684-4409",
            "fax_number": "270-588-7138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "161 FORT WASHINGTON AVE",
            "address_2": "12TH FLOOR, ROOM 1206A",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100323729",
            "telephone_number": "212-305-5317",
            "fax_number": "212-795-1859"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NORD",
        "first_name": "KRISTIN",
        "middle_name": "MAGNUSON",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-24",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NY",
            "license": "233383",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.