Provider Demographics
NPI:1114950094
Name:KANTROWICH, PAUL J (OD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:J
Last Name:KANTROWICH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10170-0002
Mailing Address - Country:US
Mailing Address - Phone:212-697-0777
Mailing Address - Fax:212-557-4414
Practice Address - Street 1:420 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10170-0002
Practice Address - Country:US
Practice Address - Phone:212-697-0777
Practice Address - Fax:212-557-4414
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV003325-1152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management