Provider Demographics
NPI:1588820666
Name:KRUEGER, CHARLES S (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:S
Last Name:KRUEGER
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 1:217 N 8TH ST
Mailing Address - Street 2:
Mailing Address - City:SURF CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08008-5304
Mailing Address - Country:US
Mailing Address - Phone:609-361-0789
Mailing Address - Fax:609-361-0789
Practice Address - Street 1:217 N 8TH ST
Practice Address - Street 2:
Practice Address - City:SURF CITY
Practice Address - State:NJ
Practice Address - Zip Code:08008-5304
Practice Address - Country:US
Practice Address - Phone:609-361-0789
Practice Address - Fax:609-361-0789
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02082100208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery