Provider Demographics
NPI:1568198521
Name:KRYSHTAL, IVAN
Entity Type:Individual
Prefix:DR
First Name:IVAN
Middle Name:
Last Name:KRYSHTAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 E 18TH ST APT 4K
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-7566
Mailing Address - Country:US
Mailing Address - Phone:646-288-3400
Mailing Address - Fax:
Practice Address - Street 1:1 BROOKDALE PLZ
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-3139
Practice Address - Country:US
Practice Address - Phone:718-240-6347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-31
Last Update Date:2022-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program