Basic Information
| Provider Information | |||||||||
| NPI: | 1003054214 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ATANASSOV | ||||||||
| FirstName: | KRASSIMIR | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 707 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MIDDLETOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109402650 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453337575 | ||||||||
| FaxNumber: | 8453331343 | ||||||||
| Practice Location | |||||||||
| Address1: | 707 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MIDDLETOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109402650 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453337575 | ||||||||
| FaxNumber: | 8453331343 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2009 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0102X | ME128544 | FL | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 2086S0102X | 263018 | NY | Y | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care |
ID Information
| ID | Type | State | Issuer | Description | 03596898 | 05 | NY | MEDICAID |