Provider Demographics
NPI:1275527582
Name:KRANT, JESSICA J (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:J
Last Name:KRANT
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:450 CLARKSON AVE
Mailing Address - Street 2:BOX 46- DERMATOLOGY
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-2056
Mailing Address - Country:US
Mailing Address - Phone:718-270-1229
Mailing Address - Fax:718-270-2794
Practice Address - Street 1:450 CLARKSON AVE
Practice Address - Street 2:SUITE H
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2056
Practice Address - Country:US
Practice Address - Phone:718-270-1230
Practice Address - Fax:718-270-2794
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2012-08-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY220067-1207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02427576Medicaid
NYH51416Medicare UPIN
NY02427576Medicaid