Healthcare Provider Details

I. General information

NPI: 1124028402
Provider Name (Legal Business Name): DAVID M KRUMHOLZ OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 01/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 W 42ND ST SUNYSCO, ROOM 923
NEW YORK NY
10036-8005
US

IV. Provider business mailing address

33 W 42ND ST SUNYSCO, ROOM 923
NEW YORK NY
10036-8005
US

V. Phone/Fax

Practice location:
  • Phone: 212-938-4001
  • Fax:
Mailing address:
  • Phone: 212-938-4172
  • Fax: 212-938-5819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberVUT004588
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: