Provider Demographics
NPI:1386752814
Name:GREGORY B KROHEL MD PC
Entity type:Organization
Organization Name:GREGORY B KROHEL MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:B
Authorized Official - Last Name:KROHEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-271-6293
Mailing Address - Street 1:2200 BURDETT AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-2451
Mailing Address - Country:US
Mailing Address - Phone:518-271-6293
Mailing Address - Fax:518-271-6394
Practice Address - Street 1:2200 BURDETT AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-2451
Practice Address - Country:US
Practice Address - Phone:518-271-6293
Practice Address - Fax:518-271-6394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY137990207W00000X
NY210538207W00000X
NY207362207W00000X
NY211098207W00000X
NY240012207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
55441AMedicare ID - Type Unspecified