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General NPI Number Information
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NPI Number | 1255320891
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Entity Type | Individual
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Provider Name | IGOR A. KRAEV M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/17/2005
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Last Update Date | 08/08/2019
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Provider Practice Location Address
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Address Line | 1201 NOTT STREET SUITE 307
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City | SCHENECTADY
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State | NY
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Zip | 12308-2589
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Country | US
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Telephone | 518-243-3388
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Fax | 518-243-1329
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Provider Business Mailing Address
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Address Line | 4900 BROAD RD STE 3M
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City | SYRACUSE
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State | NY
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Zip | 13215-2265
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Country | US
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Telephone | 315-464-7010
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Fax | 154-643-6982
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 205135
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License Number State | NY
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