MEDICARE: KRISHTUL MEDICAL GROUP, P.C.

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	207Q00000X	Family Medicine Physician	237383-1	NY

General Provider Information

NPI Number	:	1851572895
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KRISHTUL MEDICAL GROUP, P.C.

Provider Business Mailing Address
First Line	:	11 PENN PLZ
Second Line	:	SUITE 500
City	:	NEW YORK
State	:	NY
Zip	:	10001-2006
Country	:	US
Telephone Number	:	866-366-3060
Fax Number	:	202-349-0354

Provider Business Practice Location Address
First Line	:	436 86TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-4708
Country	:	US
Telephone Number	:	718-238-0456
Fax Number	:	718-238-0458

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	ALEXABDER KRISHTUL
Credential	:	MD
Telephone Number	:	866-366-3060

Provider Enumeration Date	:	11/19/2007
Last Update Date	:	11/19/2007

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