Provider Demographics
NPI:1609930288
Name:KRAMARCZYK, WALDEMAR (MD)
Entity Type:Individual
Prefix:
First Name:WALDEMAR
Middle Name:
Last Name:KRAMARCZYK
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 1:5968 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-2733
Mailing Address - Country:US
Mailing Address - Phone:718-894-2905
Mailing Address - Fax:718-326-1921
Practice Address - Street 1:5968 GRAND AVE
Practice Address - Street 2:
Practice Address - City:MASPETH
Practice Address - State:NY
Practice Address - Zip Code:11378-2733
Practice Address - Country:US
Practice Address - Phone:718-894-2905
Practice Address - Fax:718-326-1921
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY191261207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDP348OtherOXF
NY4370011OtherAETNA
NY01319Medicare ID - Type Unspecified
NYDP348OtherOXF