Healthcare Provider Details

I. General information

NPI: 1487634952
Provider Name (Legal Business Name): ERIC KRUGER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 04/27/2020
Certification Date: 04/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

256 COUNTY HOUSE RD
CLARKSBORO NJ
08020-1395
US

IV. Provider business mailing address

506 PINE ST
PHILADELPHIA PA
19106-4111
US

V. Phone/Fax

Practice location:
  • Phone: 856-224-6979
  • Fax: 609-939-0284
Mailing address:
  • Phone: 609-923-4409
  • Fax: 609-939-0284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA03500500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: