Healthcare Provider Details

I. General information

NPI: 1497623706
Provider Name (Legal Business Name): DIALOG HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2025
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3939 PENHURST AVE
BALTIMORE MD
21215-5632
US

IV. Provider business mailing address

50 CHESTNUT RIDGE RD STE 130
MONTVALE NJ
07645-1841
US

V. Phone/Fax

Practice location:
  • Phone: 212-734-6621
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: BEREL KRUG
Title or Position: OWNER
Credential:
Phone: 845-579-5639