Provider Demographics
NPI:1073542866
Name:KRONISH, IAN M (MD)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:M
Last Name:KRONISH
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 1:622 W 168TH ST
Mailing Address - Street 2:PH9-311
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3720
Mailing Address - Country:US
Mailing Address - Phone:212-342-1335
Mailing Address - Fax:212-342-3431
Practice Address - Street 1:622 W 168TH ST
Practice Address - Street 2:VC-205
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3720
Practice Address - Country:US
Practice Address - Phone:212-305-6354
Practice Address - Fax:212-305-6279
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY247388207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I05008Medicare UPIN
224AX1Medicare ID - Type Unspecified