Healthcare Provider Details

I. General information

NPI: 1760858674
Provider Name (Legal Business Name): KRYSTYNA KORYZMA NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2015
Last Update Date: 03/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5001 STATE HIGHWAY 23
ONEONTA NY
13820-4508
US

IV. Provider business mailing address

PO BOX 500
ELLICOTTVILLE NY
14731-0500
US

V. Phone/Fax

Practice location:
  • Phone: 607-376-5346
  • Fax: 607-376-5347
Mailing address:
  • Phone: 716-699-9032
  • Fax: 716-699-9035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF342399
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF07151355
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: