Healthcare Provider Details

I. General information

NPI: 1336051846
Provider Name (Legal Business Name): KATHERINE KRUZHILINA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 PELHAM PKWY S RM 5N50
BRONX NY
10461-1119
US

IV. Provider business mailing address

440 NEPTUNE AVE APT 11C
BROOKLYN NY
11224-4634
US

V. Phone/Fax

Practice location:
  • Phone: 718-918-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number036284
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number036284
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number036284
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: