=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487604518
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NATALYA KRICHMAR M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2006
-----------------------------------------------------
Last Update Date | 01/26/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 BOUNDARY AVE SUITE 200
-----------------------------------------------------
City | MASSAPEQUA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11758-1152
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-755-2404
-----------------------------------------------------
Fax | 516-755-2405
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 235 SADDLE LN
-----------------------------------------------------
City | SYOSSET
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11791-4428
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-573-5668
-----------------------------------------------------
Fax | 516-802-3970
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 232567
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RH0003X
-----------------------------------------------------
Taxonomy Name | Hematology & Oncology Physician
-----------------------------------------------------
License Number | 232567
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------