Provider Demographics
NPI:1114995081
Name:RAGNARSSON, KRISTJAN (MD)
Entity Type:Individual
Prefix:
First Name:KRISTJAN
Middle Name:
Last Name:RAGNARSSON
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:BOX 1240B
Mailing Address - Street 2:5 E. 98TH STREET 6TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029
Mailing Address - Country:US
Mailing Address - Phone:212-241-9469
Mailing Address - Fax:212-369-6389
Practice Address - Street 1:BOX 1240B
Practice Address - Street 2:5 E. 98TH STREET 6TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029
Practice Address - Country:US
Practice Address - Phone:212-241-9469
Practice Address - Fax:212-369-6389
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY129465-1225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00238399Medicaid
NYB12609Medicare UPIN
NY304181Medicare ID - Type Unspecified