Provider Demographics
NPI:1922119767
Name:KRONICK, GARY ARCHER (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:ARCHER
Last Name:KRONICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:711 TROY SCHENECTADY RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2442
Mailing Address - Country:US
Mailing Address - Phone:518-782-3700
Mailing Address - Fax:518-782-3799
Practice Address - Street 1:711 TROY SCHENECTADY RD
Practice Address - Street 2:SUITE 104
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-2442
Practice Address - Country:US
Practice Address - Phone:518-783-3110
Practice Address - Fax:518-783-8510
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY142320207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01160223Medicaid
NY01160223Medicaid
NYB81943Medicare UPIN
NYBB8557Medicare PIN