Provider Demographics
NPI:1992810220
Name:KRUSZYNSKI, KARL (PA)
Entity type:Individual
Prefix:
First Name:KARL
Middle Name:
Last Name:KRUSZYNSKI
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:969 MAIN ST STE D
Mailing Address - Street 2:
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-1791
Mailing Address - Country:US
Mailing Address - Phone:845-896-7730
Mailing Address - Fax:845-896-0273
Practice Address - Street 1:40 HURLEY AVE STE 10
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-3738
Practice Address - Country:US
Practice Address - Phone:845-338-3200
Practice Address - Fax:845-338-3233
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009151-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY009151-1OtherLICENSE
NY02584563Medicaid