Provider Demographics
NPI:1689246225
Name:KRIVINSKAS, MATTHEW J
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:J
Last Name:KRIVINSKAS
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 1:25021 AURORA RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44146-1767
Mailing Address - Country:US
Mailing Address - Phone:216-392-1403
Mailing Address - Fax:
Practice Address - Street 1:25021 AURORA RD
Practice Address - Street 2:
Practice Address - City:BEDFORD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44146-1767
Practice Address - Country:US
Practice Address - Phone:216-392-1403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor