Healthcare Provider Details

I. General information

NPI: 1023113214
Provider Name (Legal Business Name): MAURICE KRASNOW PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 08/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

334 W 86TH ST
NEW YORK NY
10024-3106
US

IV. Provider business mailing address

334 W 86TH ST
NEW YORK NY
10024-3106
US

V. Phone/Fax

Practice location:
  • Phone: 212-787-2190
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License Number000205
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: