Basic Information
| Provider Information | |||||||||
| NPI: | 1174589246 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KORSAKOFF | ||||||||
| FirstName: | KRISTOPHER | ||||||||
| MiddleName: | PAUL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20 GRAND STREET | ||||||||
| Address2: | 3RD FL | ||||||||
| City: | WARWICK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109901035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8459873901 | ||||||||
| FaxNumber: | 8459875979 | ||||||||
| Practice Location | |||||||||
| Address1: | 212 STATE ROUTE 94 | ||||||||
| Address2: | SUITE 1A | ||||||||
| City: | VERNON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07462 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9738646029 | ||||||||
| FaxNumber: | 9738641010 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2006 | ||||||||
| LastUpdateDate: | 08/02/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 235632 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207RG0100X | MA72514 | NJ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207RG0100X | MD425976 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.