Healthcare Provider Details

I. General information

NPI: 1003971813
Provider Name (Legal Business Name): VICTOR KRUPITSKY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 12/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2467 OCEAN AVE
BROOKLYN NY
11229
US

IV. Provider business mailing address

2467 OCEAN AVE
BROOKLYN NY
11229
US

V. Phone/Fax

Practice location:
  • Phone: 718-891-2525
  • Fax: 718-332-4455
Mailing address:
  • Phone: 718-891-2525
  • Fax: 718-332-4455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number163702
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number163702
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: