Individual provider Active NPI

Paul Kronenberg, M.D.

  • Internal Medicine Physician
  • Syracuse, NY
National Provider Identifier
1336143783
Registry record updated Dec 5, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
107062 Issued in NY
Practice address
739 Irving Ave
Ste 200
Syracuse, NY 13210-1668
Phone
(315) 479-5070
Fax
(315) 701-2520
NPI assigned
Jun 13, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 107062 NY Primary

Addresses

Primary practice location

739 Irving Ave
Ste 200
Syracuse, NY 13210-1668

Mailing address

739 Irving Ave
Ste 200
Syracuse, NY 13210-1668
Phone (315) 479-5070

Other identifiers 1

IdentifierTypeStateIssuer
00559999MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1118620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1196812800000",
    "number": "1336143783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "739 IRVING AVE",
            "address_2": "STE 200",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132101668",
            "telephone_number": "315-479-5070",
            "fax_number": "315-701-2520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "739 IRVING AVE",
            "address_2": "STE 200",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132101668",
            "telephone_number": "315-479-5070",
            "fax_number": "315-701-2520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRONENBERG",
        "first_name": "PAUL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-13",
        "last_updated": "2007-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "107062",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00559999",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.