Provider Demographics
NPI:1245307594
Name:KREITZER, LYNDA ROBIN (DPM)
Entity type:Individual
Prefix:
First Name:LYNDA
Middle Name:ROBIN
Last Name:KREITZER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:LYNDA
Other - Middle Name:ROBIN
Other - Last Name:COHEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:316 SOUTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:NORTH SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212
Mailing Address - Country:US
Mailing Address - Phone:315-452-1314
Mailing Address - Fax:315-452-1410
Practice Address - Street 1:316 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:NORTH SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13212
Practice Address - Country:US
Practice Address - Phone:315-452-1314
Practice Address - Fax:315-452-1410
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003033213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBB5621OtherMEDICARE
NY00590538Medicaid
NY480022823OtherMCAR RAILROAD
NY480022823OtherMCAR RAILROAD
NY0909100001Medicare NSC