Provider Demographics
NPI:1245602143
Name:VISION NYC JONATHAN KRUH MD PLLC
Entity Type:Organization
Organization Name:VISION NYC JONATHAN KRUH MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:
Authorized Official - Last Name:KRUH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-799-3648
Mailing Address - Street 1:24039 66TH AVE
Mailing Address - Street 2:
Mailing Address - City:DOUGLASTON
Mailing Address - State:NY
Mailing Address - Zip Code:11362-1924
Mailing Address - Country:US
Mailing Address - Phone:646-799-3648
Mailing Address - Fax:212-225-8416
Practice Address - Street 1:25 5TH AVE
Practice Address - Street 2:SUITE 1B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4307
Practice Address - Country:US
Practice Address - Phone:646-799-3648
Practice Address - Fax:212-225-8416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-30
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY260221207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03571744Medicaid
NYG400089342Medicare PIN