Provider Demographics
NPI:1205914405
Name:KRUMHOLZ, DAVID (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:KRUMHOLZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 50 71 RD
Mailing Address - Street 2:FOREST HILLS
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:11375
Mailing Address - Country:US
Mailing Address - Phone:718-268-1112
Mailing Address - Fax:718-268-1113
Practice Address - Street 1:110 50 71 RD
Practice Address - Street 2:FOREST HILLS
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:11375
Practice Address - Country:US
Practice Address - Phone:718-268-1112
Practice Address - Fax:718-268-1113
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY151088207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B14519Medicare UPIN
46716Medicare ID - Type Unspecified