Provider Demographics
NPI:1649490442
Name:KRUSHELNYCKY, MARK ANDREW (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ANDREW
Last Name:KRUSHELNYCKY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:39 E 78TH ST
Mailing Address - Street 2:SUITE 501
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-0213
Mailing Address - Country:US
Mailing Address - Phone:212-396-0204
Mailing Address - Fax:212-396-0746
Practice Address - Street 1:39 E 78TH ST
Practice Address - Street 2:SUITE 501
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-0213
Practice Address - Country:US
Practice Address - Phone:212-396-0204
Practice Address - Fax:212-396-0746
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
NY2086712084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry