MEDICARE: MR. MICHAEL KRYAGIN MS,PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	40QA00892000	NJ

General Provider Information

NPI Number	:	1114118858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL KRYAGIN MS,PT

Provider Business Mailing Address
First Line	:	305 W GRAND AVE STE 500
Second Line	:
City	:	MONTVALE
State	:	NJ
Zip	:	07645-1813
Country	:	US
Telephone Number	:	201-391-8282
Fax Number	:	201-391-8299

Provider Business Practice Location Address
First Line	:	305 W GRAND AVE
Second Line	:
City	:	MONTVALE
State	:	NJ
Zip	:	07645-1813
Country	:	US
Telephone Number	:	201-291-8282
Fax Number	:	201-391-8299

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2007
Last Update Date	:	10/02/2020

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