Provider Demographics
NPI:1447217856
Name:KRESEL, TOBEY ANN (MD)
Entity type:Individual
Prefix:
First Name:TOBEY
Middle Name:ANN
Last Name:KRESEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3448 STATE ROUTE 31
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-9231
Mailing Address - Country:US
Mailing Address - Phone:315-622-6595
Mailing Address - Fax:315-622-3298
Practice Address - Street 1:3448 STATE ROUTE 31
Practice Address - Street 2:
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027-9231
Practice Address - Country:US
Practice Address - Phone:315-622-6595
Practice Address - Fax:315-622-3298
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219390208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02233223Medicaid
NYJ400010623Medicare PIN