Healthcare Provider Details

I. General information

NPI: 1598845356
Provider Name (Legal Business Name): RICHARD BOHN KRUEGER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 EAST 68TH STREET SUITE 1H
NEW YORK NY
10021-6024
US

IV. Provider business mailing address

210 EAST 68TH STREET SUITE 1H
NEW YORK NY
10021-6024
US

V. Phone/Fax

Practice location:
  • Phone: 212-517-6624
  • Fax: 212-517-4073
Mailing address:
  • Phone: 212-517-6624
  • Fax: 212-517-4073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number177371
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number177371
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number177371
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: