Provider Demographics
NPI:1720972334
Name:KRYSHTALSKYJ, MICHAEL TIMOTHY (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:TIMOTHY
Last Name:KRYSHTALSKYJ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 BLOOMINGDALE AVE.
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087
Mailing Address - Country:US
Mailing Address - Phone:647-938-4450
Mailing Address - Fax:
Practice Address - Street 1:123 BLOOMINGDALE AVE.
Practice Address - Street 2:SUITE 102
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087
Practice Address - Country:US
Practice Address - Phone:610-687-8771
Practice Address - Fax:610-687-8773
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-06
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA12621700207W00000X
DEC1-0028100207W00000X
PAMD489386207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology