Provider Demographics
NPI:1598389330
Name:KRECKEL, MICHAEL
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:KRECKEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 E POPLAR AVE UNIT 1C
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08260-5249
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1175 DEHIRSCH AVE
Practice Address - Street 2:
Practice Address - City:WOODBINE
Practice Address - State:NJ
Practice Address - Zip Code:08270-2401
Practice Address - Country:US
Practice Address - Phone:609-471-4658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-07
Last Update Date:2020-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01793300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist