Provider Demographics
NPI:1780674564
Name:KREIENBERG, PAUL BOYD (MD)
Entity Type:Individual
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First Name:PAUL
Middle Name:BOYD
Last Name:KREIENBERG
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Gender:M
Credentials:MD
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Mailing Address - Street 1:391 MYRTLE AVE., SUITE 5
Mailing Address - Street 2:THE VASCULAR GROUP, PLLC
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-3797
Mailing Address - Country:US
Mailing Address - Phone:518-262-5640
Mailing Address - Fax:518-262-9413
Practice Address - Street 1:391 MYRTLE AVE., SUITE 5
Practice Address - Street 2:THE VASCULAR GROUP, PLLC
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3412
Practice Address - Country:US
Practice Address - Phone:518-262-5640
Practice Address - Fax:518-262-9413
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2017-09-19
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Provider Licenses
StateLicense IDTaxonomies
NY1954692085R0204X, 208G00000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01620864Medicaid
NY0380G810Medicare ID - Type UnspecifiedDOWNSTATE MEDICARE
G21450Medicare UPIN
NY01620864Medicaid