1942345806 NPI number — MR. ALEKSANDR KRUCHAKOV AP, MA

Table of content: MR. ALEKSANDR KRUCHAKOV AP, MA (NPI 1942345806)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942345806 NPI number — MR. ALEKSANDR KRUCHAKOV AP, MA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KRUCHAKOV
Provider First Name:
ALEKSANDR
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
AP, MA
Provider Gender Code:
M

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:
1942345806
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2851 NE 183RD ST
Provider Second Line Business Mailing Address:
APT. 1603
Provider Business Mailing Address City Name:
AVENTURA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33160-2104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-536-9231
Provider Business Mailing Address Fax Number:
305-893-5208

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1531 N FEDERAL HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOLLYWOOD
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33020-2849
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-922-1270
Provider Business Practice Location Address Fax Number:
954-922-1273
Provider Enumeration Date:
02/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  AP1714 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225700000X , with the licence number: MA 21878 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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