Provider Demographics
NPI:1700886645
Name:KRUMHOLZ, MICHAEL PETER (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:PETER
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 1:111 E 80TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-0334
Mailing Address - Country:US
Mailing Address - Phone:212-734-5533
Mailing Address - Fax:212-717-1688
Practice Address - Street 1:111 E 80TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-0334
Practice Address - Country:US
Practice Address - Phone:212-734-5533
Practice Address - Fax:212-717-1688
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY147236207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY68D801OtherEMPIRE BC/BS
NY00951813Medicaid
NY68D801Medicare ID - Type Unspecified
NY00951813Medicaid