Provider Demographics
NPI:1386639532
Name:KRUK, RAYMOND MATTHEW (NP)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:MATTHEW
Last Name:KRUK
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 MIDDLEBUSH RD
Mailing Address - Street 2:
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-4098
Mailing Address - Country:US
Mailing Address - Phone:845-297-6450
Mailing Address - Fax:845-297-6160
Practice Address - Street 1:66 MIDDLEBUSH RD
Practice Address - Street 2:
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-4098
Practice Address - Country:US
Practice Address - Phone:845-297-6450
Practice Address - Fax:845-297-6160
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF331724363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYMK0343145OtherDEA