Provider Demographics
NPI:1003892613
Name:KRYNYCKYI, BORYS (MD)
Entity Type:Individual
Prefix:
First Name:BORYS
Middle Name:
Last Name:KRYNYCKYI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 LAUREL CT
Mailing Address - Street 2:
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736-1529
Mailing Address - Country:US
Mailing Address - Phone:732-528-0026
Mailing Address - Fax:
Practice Address - Street 1:1514 STATE ROUTE 138
Practice Address - Street 2:PCMI
Practice Address - City:WALL
Practice Address - State:NJ
Practice Address - Zip Code:07719-3706
Practice Address - Country:US
Practice Address - Phone:732-681-2700
Practice Address - Fax:732-681-2701
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY194637-1207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01787053Medicaid
NYG60511Medicare UPIN
NY01787053Medicaid