Basic Information
| Provider Information | |||||||||
| NPI: | 1962449025 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KRING | ||||||||
| FirstName: | LAWRENCE | ||||||||
| MiddleName: | IVAN | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 50 LEROY ST | ||||||||
| Address2: | |||||||||
| City: | POTSDAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 136761786 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3152653300 | ||||||||
| FaxNumber: | 3152616025 | ||||||||
| Practice Location | |||||||||
| Address1: | 80 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 136171450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3152615871 | ||||||||
| FaxNumber: | 3157143068 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2006 | ||||||||
| LastUpdateDate: | 01/24/2018 | ||||||||
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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 | 207R00000X | 238150-1 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | 238105-1 | NY | N | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | P010238150 | 01 | NY | BLUE CROSS BLUE SH | OTHER | 1962449025 | 01 | NY | FIDELIS | OTHER | 238150 | 01 | LICENSE | OTHER | 00041188601 | 01 | NY | BLUE SHIELD OF NENY | OTHER | 02753419 | 05 | NY | MEDICAID | P000000208907 | 01 | NY | GHI FHP | OTHER | RB1409 | 01 | NY | PALMETTO GBA | OTHER |