Provider Demographics
NPI:1245336239
Name:ANDREW E KRUPITSKY DO PA
Entity type:Organization
Organization Name:ANDREW E KRUPITSKY DO PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:E
Authorized Official - Last Name:KRUPITSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:407-332-6366
Mailing Address - Street 1:249 MAITLAND AVE
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-4906
Mailing Address - Country:US
Mailing Address - Phone:407-332-6366
Mailing Address - Fax:407-830-4300
Practice Address - Street 1:249 MAITLAND AVE
Practice Address - Street 2:SUITE 1000
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-4906
Practice Address - Country:US
Practice Address - Phone:407-332-6366
Practice Address - Fax:407-830-4300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 5574204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK0954Medicare ID - Type UnspecifiedGROUP ID NUMBER