Healthcare Provider Details

I. General information

NPI: 1790332278
Provider Name (Legal Business Name): ERIC KRUGER MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2019
Last Update Date: 08/20/2019
Certification Date:
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:
Mailing address:
  • Phone: 609-923-4409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ERIC KRUGER
Title or Position: OWNER
Credential: MD
Phone: 609-923-4409