Individual ProviderVitaliy KrolInternal MedicineAllopathic & Osteopathic PhysiciansPractice Address2200 Northern Blvd Ste 205, Greenvale, NY 11548-1220(516) 767-7771PECOS EnrollmentBased on the most recent information from CMS, provider Vitaliy Krol is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1881817237Provider TypeIndividualFull NameKrol, VitaliyCredentialDOGenderMaleSole ProprietorNoEnumeration Date4/11/2007Last Updated3/21/2023Contact InformationPractice LocationPractice Address2200 Northern Blvd Ste 205, Greenvale, NY 11548-1220Phone(516) 767-7771Fax(516) 767-7765Mailing LocationMailing Address2200 Northern Blvd Ste 205, Greenvale, NY 11548-1220Phone(516) 767-7771Fax(516) 767-7765Provider TaxonomiesCodeDescriptionLicenseCode207RI0200XPrimaryDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicense243332New YorkProvider IdentifiersIDDescriptionIssuerID02959960DescriptionMedicaidIssuerUnlistedNew YorkID112814003DescriptionOtherIssuerTAX ID