Provider Demographics
NPI:1114118858
Name:KRYAGIN, MICHAEL (MS,PT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:KRYAGIN
Suffix:
Gender:M
Credentials:MS,PT
Other - Prefix:MR
Other - First Name:MICHAEL
Other - Middle Name:
Other - Last Name:KRYAGIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSPT
Mailing Address - Street 1:305 W GRAND AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:MONTVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07645-1813
Mailing Address - Country:US
Mailing Address - Phone:201-391-8282
Mailing Address - Fax:201-391-8299
Practice Address - Street 1:305 W GRAND AVE
Practice Address - Street 2:
Practice Address - City:MONTVALE
Practice Address - State:NJ
Practice Address - Zip Code:07645-1813
Practice Address - Country:US
Practice Address - Phone:201-291-8282
Practice Address - Fax:201-391-8299
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00892000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ081593SZWMedicare PIN