Provider Demographics
NPI:1811196744
Name:KRIEGER, PAUL HOWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:HOWARD
Last Name:KRIEGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 1ST AVE
Mailing Address - Street 2:APT 13 A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-4933
Mailing Address - Country:US
Mailing Address - Phone:646-546-4478
Mailing Address - Fax:
Practice Address - Street 1:390 FIRST AVE
Practice Address - Street 2:APT 13 A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010
Practice Address - Country:US
Practice Address - Phone:646-546-4478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY243754207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02889985Medicaid
NY02889985Medicaid
NY091P638491Medicare PIN