Basic Information
| Provider Information | |||||||||
| NPI: | 1679519433 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KRIZAR | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2000 | ||||||||
| Address2: | |||||||||
| City: | HUDSON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125342000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5188288363 | ||||||||
| FaxNumber: | 5186973388 | ||||||||
| Practice Location | |||||||||
| Address1: | 1301 RIVER ST | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | VALATIE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 121849694 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5187581766 | ||||||||
| FaxNumber: | 5187581439 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2006 | ||||||||
| LastUpdateDate: | 07/16/2007 | ||||||||
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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 | 207Q00000X | 200148 | NY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 01699274 | 05 | NY | MEDICAID |