Provider Demographics
NPI:1598845356
Name:KRUEGER, RICHARD BOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:BOHN
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 1:210 EAST 68TH STREET
Mailing Address - Street 2:SUITE 1H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-6024
Mailing Address - Country:US
Mailing Address - Phone:212-517-6624
Mailing Address - Fax:212-517-4073
Practice Address - Street 1:210 EAST 68TH STREET
Practice Address - Street 2:SUITE 1H
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-6024
Practice Address - Country:US
Practice Address - Phone:212-517-6624
Practice Address - Fax:212-517-4073
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1773712084F0202X, 2084P0800X, 2084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY177371OtherNEW YORK STATE LISCENCE #
NJMA 53098OtherNEW JERSEY LISCENCE NUMBE
NJMA 53098OtherNEW JERSEY LISCENCE NUMBE
NY25F333Medicare ID - Type UnspecifiedMEDICARE ID NUMBER