Healthcare Provider Details

I. General information

NPI: 1255320891
Provider Name (Legal Business Name): IGOR A. KRAEV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 08/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 NOTT STREET SUITE 307
SCHENECTADY NY
12308-2589
US

IV. Provider business mailing address

4900 BROAD RD STE 3M
SYRACUSE NY
13215-2265
US

V. Phone/Fax

Practice location:
  • Phone: 518-243-3388
  • Fax: 518-243-1329
Mailing address:
  • Phone: 315-464-7010
  • Fax: 154-643-6982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number205135
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: