Provider Demographics
NPI:1659344570
Name:KRUMHOLTZ, IRA (OD)
Entity Type:Individual
Prefix:DR
First Name:IRA
Middle Name:
Last Name:KRUMHOLTZ
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 MARSHALL DR
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-2911
Mailing Address - Country:US
Mailing Address - Phone:732-819-7777
Mailing Address - Fax:
Practice Address - Street 1:3391 ROUTE 27
Practice Address - Street 2:SUITE 127
Practice Address - City:FRANKLIN PARK
Practice Address - State:NJ
Practice Address - Zip Code:08823
Practice Address - Country:US
Practice Address - Phone:732-940-0735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJOA5160152W00000X
NYT5261152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U34160Medicare UPIN
KR186848Medicare ID - Type Unspecified