1174698872 NPI number — ANNA S KRAYN PHD PC

Table of content: (NPI 1174698872)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174698872 NPI number — ANNA S KRAYN PHD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANNA S KRAYN PHD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174698872
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/08/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1665
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARAMUS
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07653-1665
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-986-9872
Provider Business Mailing Address Fax Number:
201-986-0397

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3043 OCEAN AVE
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11235-3497
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-934-5907
Provider Business Practice Location Address Fax Number:
201-986-0397
Provider Enumeration Date:
11/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KRAYN
Authorized Official First Name:
ANNA
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
201-986-9872

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  PR048894 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: N3W181 . This is a "MEDICARE ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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