Healthcare Provider Details

I. General information

NPI: 1205836509
Provider Name (Legal Business Name): BRUCE H KRAUT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 MAIN ST
LAWRENCEVILLE NJ
08648-1600
US

IV. Provider business mailing address

PO BOX 6011
LAWRENCEVILLE NJ
08648-0011
US

V. Phone/Fax

Practice location:
  • Phone: 609-896-0391
  • Fax:
Mailing address:
  • Phone: 609-896-0391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberME68627
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME68627
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: