Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 163702 | NY |
N | 208000000X | Pediatrician | 163702 | NY |
NPI | 1003971813 |
---|---|
Provider Name | Mr. Victor Krupitsky |
First Address | Brooklyn, NY 11229 |
Second Address | Brooklyn, NY 11229 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2006 |
Last Update Date | 12/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00907497 | (05) | NY |
50D181 | (02) | NY |
A63021 | (02) |