Provider Demographics
NPI:1851572895
Name:KRISHTUL MEDICAL GROUP, P.C.
Entity Type:Organization
Organization Name:KRISHTUL MEDICAL GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALEXABDER
Authorized Official - Middle Name:
Authorized Official - Last Name:KRISHTUL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:866-366-3060
Mailing Address - Street 1:11 PENN PLZ
Mailing Address - Street 2:SUITE 500
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-2006
Mailing Address - Country:US
Mailing Address - Phone:866-366-3060
Mailing Address - Fax:202-349-0354
Practice Address - Street 1:436 86TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-4708
Practice Address - Country:US
Practice Address - Phone:718-238-0456
Practice Address - Fax:718-238-0458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY237383-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty