Provider Demographics
NPI:1669025144
Name:KRAYDMAN MEDICAL, P.C.
Entity type:Organization
Organization Name:KRAYDMAN MEDICAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VALERIY
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAYDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-271-9151
Mailing Address - Street 1:49 DOLPHIN LN
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-1860
Mailing Address - Country:US
Mailing Address - Phone:631-767-7724
Mailing Address - Fax:631-271-9155
Practice Address - Street 1:49 DOLPHIN LN
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-1860
Practice Address - Country:US
Practice Address - Phone:631-767-7724
Practice Address - Fax:631-271-9155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-23
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty