MEDICARE: DR. DAVID M KRUMHOLZ OD

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	152W00000X	Optometrist	VUT004588	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C3361	OTHER	NY	MEDICARE ID

General Provider Information

NPI Number	:	1124028402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID M KRUMHOLZ OD

Provider Business Mailing Address
First Line	:	33 W 42ND ST
Second Line	:	SUNYSCO, ROOM 923
City	:	NEW YORK
State	:	NY
Zip	:	10036-8005
Country	:	US
Telephone Number	:	212-938-4172
Fax Number	:	212-938-5819

Provider Business Practice Location Address
First Line	:	33 W 42ND ST
Second Line	:	SUNYSCO, ROOM 923
City	:	NEW YORK
State	:	NY
Zip	:	10036-8005
Country	:	US
Telephone Number	:	212-938-4001
Fax Number	:

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

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	01/07/2010

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