Provider Demographics
NPI:1376596585
Name:KRAYNAK FAMILY MEDICINE, P.C.
Entity Type:Organization
Organization Name:KRAYNAK FAMILY MEDICINE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:KRAYNAK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:570-373-3121
Mailing Address - Street 1:111 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:KULPMONT
Mailing Address - State:PA
Mailing Address - Zip Code:17834-1403
Mailing Address - Country:US
Mailing Address - Phone:570-373-3121
Mailing Address - Fax:570-373-3872
Practice Address - Street 1:111 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:KULPMONT
Practice Address - State:PA
Practice Address - Zip Code:17834-1403
Practice Address - Country:US
Practice Address - Phone:570-373-3121
Practice Address - Fax:570-373-3872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-009229-L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017410150005Medicaid
PA0017410150005Medicaid
PA893069Medicare PIN