Healthcare Provider Details

I. General information

NPI: 1215668710
Provider Name (Legal Business Name): PAVEL KRUPENIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2022
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 E 41ST ST FL 10
NEW YORK NY
10017-6739
US

IV. Provider business mailing address

222 E 41ST ST FL 10
NEW YORK NY
10017-6739
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-7744
  • Fax:
Mailing address:
  • Phone: 212-263-7744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number341281
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: