Provider Demographics
NPI:1487634952
Name:KRUGER, ERIC (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:KRUGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 PINE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-4111
Mailing Address - Country:US
Mailing Address - Phone:609-923-4409
Mailing Address - Fax:609-939-0284
Practice Address - Street 1:256 COUNTY HOUSE RD
Practice Address - Street 2:
Practice Address - City:CLARKSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08020-1395
Practice Address - Country:US
Practice Address - Phone:856-224-6979
Practice Address - Fax:609-939-0284
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03500500207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1952102Medicaid
NJC63089Medicare UPIN
NJKR631949A04Medicare ID - Type Unspecified