Provider Demographics
NPI:1720019565
Name:P KRAWITZ MD P.C.
Entity Type:Organization
Organization Name:P KRAWITZ MD P.C.
Other - Org Name:GERALD BLUMENTHAL, M.D., CHARLES I. BLOOMGARDEN, M.D., P.C. AND BERNAR
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-223-0400
Mailing Address - Street 1:755 PARK AVENUE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-3972
Mailing Address - Country:US
Mailing Address - Phone:631-223-0400
Mailing Address - Fax:631-421-2689
Practice Address - Street 1:755 PARK AVENUE
Practice Address - Street 2:SUITE 100
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3972
Practice Address - Country:US
Practice Address - Phone:631-223-0400
Practice Address - Fax:631-421-2689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X, 207W00000X
NY166763-1207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW6U251Medicare UPIN
NYE55815Medicare UPIN