Healthcare Provider Details

I. General information

NPI: 1144215344
Provider Name (Legal Business Name): STEVEN DAVID KRONICK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 10/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1A PINE WEST PLZ
ALBANY NY
12205-5556
US

IV. Provider business mailing address

1A PINE WEST PLZ
ALBANY NY
12205-5556
US

V. Phone/Fax

Practice location:
  • Phone: 518-862-1665
  • Fax: 518-862-1668
Mailing address:
  • Phone: 518-862-1665
  • Fax: 518-862-1668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number165061
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: