Provider Demographics
NPI:1942971569
Name:GENE L KRISHINGNER JR MD PA
Entity Type:Organization
Organization Name:GENE L KRISHINGNER JR MD PA
Other - Org Name:GENE L KRISHINGNER JR MD PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GENE
Authorized Official - Middle Name:L
Authorized Official - Last Name:KRISHINGNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-304-6249
Mailing Address - Street 1:147 MORAY LN
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-4120
Mailing Address - Country:US
Mailing Address - Phone:321-304-6249
Mailing Address - Fax:
Practice Address - Street 1:2572 W STATE ROAD 426 STE 1040
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-8389
Practice Address - Country:US
Practice Address - Phone:321-304-6249
Practice Address - Fax:321-304-6004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-23
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty