Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 293148 | NY |
N | 207P00000X | Emergency Physician | OS15744 | FL |
NPI | 1003249301 |
---|---|
Provider Name | Dr. Calvin C. Krom III |
First Address | New York, NY 10006-3003 |
Second Address | New York, NY 10006 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2013 |
Last Update Date | 14/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
05242228 | (05) | NY |