Provider Demographics
NPI:1124028402
Name:KRUMHOLZ, DAVID M (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:KRUMHOLZ
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 1:33 W 42ND ST
Mailing Address - Street 2:SUNYSCO, ROOM 923
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-8005
Mailing Address - Country:US
Mailing Address - Phone:212-938-4172
Mailing Address - Fax:212-938-5819
Practice Address - Street 1:33 W 42ND ST
Practice Address - Street 2:SUNYSCO, ROOM 923
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-8005
Practice Address - Country:US
Practice Address - Phone:212-938-4001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT004588152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC3361OtherMEDICARE ID
NYC3361OtherMEDICARE ID
NYC3361Medicare ID - Type Unspecified