Provider Demographics
NPI:1790883320
Name:KRYUCHKOVA, ANNA (MD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:KRYUCHKOVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2223 CLOVE RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-1523
Mailing Address - Country:US
Mailing Address - Phone:917-449-5986
Mailing Address - Fax:718-849-6523
Practice Address - Street 1:2223 CLOVE RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-1523
Practice Address - Country:US
Practice Address - Phone:917-449-5986
Practice Address - Fax:718-849-6523
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00219931207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02253703Medicaid
NY8L0251OtherBLUE SHIELD
NY5303487OtherGHI
NY02253703Medicaid