Healthcare Provider Details

I. General information

NPI: 1962917559
Provider Name (Legal Business Name): KRASIMIR KOLEV ANP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2017
Last Update Date: 05/22/2023
Certification Date: 05/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2928 DITMARS BLVD
ASTORIA NY
11105-2731
US

IV. Provider business mailing address

3046 45TH ST APT 1F
ASTORIA NY
11103-1818
US

V. Phone/Fax

Practice location:
  • Phone: 718-545-1620
  • Fax:
Mailing address:
  • Phone: 917-849-9331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF308495-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: