Provider Demographics
NPI:1922615319
Name:KRANTS, PAUL
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:KRANTS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:PAVEL
Other - Middle Name:
Other - Last Name:KRANTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:253 CORBIN PL
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-4901
Mailing Address - Country:US
Mailing Address - Phone:917-497-6168
Mailing Address - Fax:
Practice Address - Street 1:253 CORBIN PL
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-4901
Practice Address - Country:US
Practice Address - Phone:917-497-6168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1434590201174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist