Basic Information
| Provider Information | |||||||||
| NPI: | 1861604548 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KRYZAK | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | JOHN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1367 WASHINGTON AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | ALBANY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 122061048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5184892666 | ||||||||
| FaxNumber: | 1854895933 | ||||||||
| Practice Location | |||||||||
| Address1: | 430 BATH RD | ||||||||
| Address2: | |||||||||
| City: | BRUNSWICK | ||||||||
| State: | ME | ||||||||
| PostalCode: | 040112637 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2074420350 | ||||||||
| FaxNumber: | 2074420355 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2007 | ||||||||
| LastUpdateDate: | 08/13/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XS0114X | MD21175 | ME | N | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Adult Reconstructive Orthopaedic Surgery | 207X00000X | MD21175 | ME | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.