MEDICARE: TRACEY JAY KRZANOWSKI MD

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	207L00000X	Anesthesiology Physician	25MA07935600	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154306637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACEY JAY KRZANOWSKI MD

Provider Business Mailing Address
First Line	:	100 ROUTE 59
Second Line	:	SUITE 105
City	:	SUFFERN
State	:	NY
Zip	:	10901-4927
Country	:	US
Telephone Number	:	845-357-5775
Fax Number	:	845-357-5777

Provider Business Practice Location Address
First Line	:	100 ROUTE 59
Second Line	:	SUITE 105
City	:	SUFFERN
State	:	NY
Zip	:	10901-4927
Country	:	US
Telephone Number	:	845-357-5775
Fax Number	:	845-357-5777

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

Provider Enumeration Date	:	12/07/2005
Last Update Date	:	01/03/2012

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