Healthcare Provider Details

I. General information

NPI: 1437157401
Provider Name (Legal Business Name): BERNARD MAURICE KRUGER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 E 78TH ST
NEW YORK NY
10021-0497
US

IV. Provider business mailing address

170 E 78TH ST
NEW YORK NY
10021-0497
US

V. Phone/Fax

Practice location:
  • Phone: 212-772-9222
  • Fax: 212-879-7235
Mailing address:
  • Phone: 212-772-9222
  • Fax: 212-879-7235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number125489
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: