Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | MD-069301-L | PA |
NPI | 1013148618 |
---|---|
Provider Name | Dr. Kevin Krenitsky |
First Address | Babylon, NY 11702-2317 |
Second Address | Farmingdale, NY 11735-4710 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2009 |
Last Update Date | 30/07/2009 |