Healthcare Provider Details

I. General information

NPI: 1700886645
Provider Name (Legal Business Name): MICHAEL PETER KRUMHOLZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 08/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E 80TH ST
NEW YORK NY
10021-0334
US

IV. Provider business mailing address

111 E 80TH ST
NEW YORK NY
10021-0334
US

V. Phone/Fax

Practice location:
  • Phone: 212-734-5533
  • Fax: 212-717-1688
Mailing address:
  • Phone: 212-734-5533
  • Fax: 212-717-1688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number147236
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: