Healthcare Provider Details

I. General information

NPI: 1750820338
Provider Name (Legal Business Name): PENNY KRASTEFF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2017
Last Update Date: 02/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1623 KINGS HWY
BROOKLYN NY
11229
US

IV. Provider business mailing address

8721 BAY PARKWAY 4D
BROOKLYN NY
11214
US

V. Phone/Fax

Practice location:
  • Phone: 718-375-1200
  • Fax: 718-307-6871
Mailing address:
  • Phone: 347-424-3589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number665089
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: