MEDICARE: DR. YANA KRUTOSHINSKAYA M.D.

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	2084N0400X	Neurology Physician	279633	NY

General Provider Information

NPI Number	:	1932469533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YANA KRUTOSHINSKAYA M.D.

Provider Business Mailing Address
First Line	:	100 NICOLLS RD # HSC-T12
Second Line	:
City	:	STONY BROOK
State	:	NY
Zip	:	11794-0001
Country	:	US
Telephone Number	:	631-444-2599
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 NICOLLS RD # HSC-T12
Second Line	:
City	:	STONY BROOK
State	:	NY
Zip	:	11794-1523
Country	:	US
Telephone Number	:	631-444-2599
Fax Number	:

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

Provider Enumeration Date	:	05/17/2012
Last Update Date	:	11/28/2023

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