Basic Information
| Provider Information | |||||||||
| NPI: | 1427294099 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KRILL | ||||||||
| FirstName: | AARON | ||||||||
| MiddleName: | JUSTIN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 1999 MARCUS AVE STE M18 | ||||||||
| Address2: | DEPARTMENT OF PEDIATRIC UROLOGY | ||||||||
| City: | NEW HYDE PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110421023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5164666953 | ||||||||
| FaxNumber: | 5164665608 | ||||||||
| Practice Location | |||||||||
| Address1: | 1999 MARCUS AVE STE M18 | ||||||||
| Address2: | DEPARTMENT OF PEDIATRIC UROLOGY | ||||||||
| City: | NEW HYDE PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110421023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5164666953 | ||||||||
| FaxNumber: | 5164665608 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/01/2009 | ||||||||
| LastUpdateDate: | 05/19/2011 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | MD037609 | DC | N | Allopathic & Osteopathic Physicians | Urology | 2088P0231X | 259568 | NY | Y | Allopathic & Osteopathic Physicians | Urology | Pediatric Urology |
No ID Information.