Healthcare Provider Details

I. General information

NPI: 1639449093
Provider Name (Legal Business Name): CLAIRE KRUMM PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2012
Last Update Date: 10/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

266 NORTH ST SUITE A
NEWBURGH NY
12550-3131
US

IV. Provider business mailing address

266 NORTH ST SUITE A
NEWBURGH NY
12550-3131
US

V. Phone/Fax

Practice location:
  • Phone: 845-565-5737
  • Fax: 845-565-7021
Mailing address:
  • Phone: 845-565-5737
  • Fax: 845-565-7021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberF380653
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: