Provider Demographics
NPI:1336146232
Name:KORNREICH, CRAIG (MD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:
Last Name:KORNREICH
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 1:258 MERRICK RD
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-1427
Mailing Address - Country:US
Mailing Address - Phone:516-766-0345
Mailing Address - Fax:516-255-5353
Practice Address - Street 1:258 MERRICK RD
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-1427
Practice Address - Country:US
Practice Address - Phone:516-766-0345
Practice Address - Fax:516-255-5353
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204973-1207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY07U971Medicare ID - Type Unspecified
NYG75435Medicare UPIN