MEDICARE: MARK KRASNER

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	225100000X	Physical Therapist	027415	NY
2	225100000X	Physical Therapist	40QA01268300	NJ

General Provider Information

NPI Number	:	1578650750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK KRASNER

Provider Business Mailing Address
First Line	:	2510 OCEAN PKWY
Second Line	:	APT. 7G
City	:	BROOKLYN
State	:	NY
Zip	:	11235-6146
Country	:	US
Telephone Number	:	718-645-8808
Fax Number	:

Provider Business Practice Location Address
First Line	:	2510 OCEAN PKWY
Second Line	:	APT. 7G
City	:	BROOKLYN
State	:	NY
Zip	:	11235-6146
Country	:	US
Telephone Number	:	718-645-8808
Fax Number	:

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

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	01/02/2008

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