Provider Demographics
NPI:1750636924
Name:KRUMHOLZ, PAUL EDWIN (RN)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:EDWIN
Last Name:KRUMHOLZ
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-4728
Mailing Address - Country:US
Mailing Address - Phone:631-838-7818
Mailing Address - Fax:
Practice Address - Street 1:239 S 4TH ST
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-4728
Practice Address - Country:US
Practice Address - Phone:631-838-7818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-13
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY649454163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse