MEDICARE: KATHARINE KRUSHEL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	2084P0800X	Psychiatry Physician	317354	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	82808	OTHER	CT	CT LICENSE
2	205465	OTHER	CA	CA LICENSE
3	25MA12819500	OTHER	NJ	NJ LICENSE
4	ME170890	OTHER	FL	FL LICENSE
5	61343	OTHER	KY	KY LICENSE
6	317354	OTHER	NY	NY LICENSE

General Provider Information

NPI Number	:	1235767260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHARINE KRUSHEL

Provider Business Mailing Address
First Line	:	1090 AMSTERDAM AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10025-1737
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1111 AMSTERDAM AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10025-1716
Country	:	US
Telephone Number	:	332-243-1600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2020
Last Update Date	:	04/10/2026

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Directions to “ KATHARINE KRUSHEL ” Practice Location

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