Provider Demographics
NPI:1821035593
Name:KRZAN, JOHN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:KRZAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4390 QUINBY DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-7900
Mailing Address - Country:US
Mailing Address - Phone:716-312-7400
Mailing Address - Fax:716-312-7402
Practice Address - Street 1:4390 QUINBY DR
Practice Address - Street 2:SUITE E
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-7900
Practice Address - Country:US
Practice Address - Phone:716-312-7400
Practice Address - Fax:716-312-7402
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY171487-1208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01336070Medicaid