Healthcare Provider Details

I. General information

NPI: 1053303974
Provider Name (Legal Business Name): KENNETH J KROOPNICK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 08/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 NORMANSKILL BLVD
DELMAR NY
12054-1335
US

IV. Provider business mailing address

4 NORMANSKILL BLVD
DELMAR NY
12054-1335
US

V. Phone/Fax

Practice location:
  • Phone: 518-478-9423
  • Fax: 518-439-7046
Mailing address:
  • Phone: 518-478-9423
  • Fax: 518-439-7046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number173016
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: