Provider Demographics
NPI:1609907591
Name:KRUG-HYDE, AMI (PT,)
Entity Type:Individual
Prefix:
First Name:AMI
Middle Name:
Last Name:KRUG-HYDE
Suffix:
Gender:F
Credentials:PT,
Other - Prefix:
Other - First Name:AMI
Other - Middle Name:
Other - Last Name:HYDE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:5-06 LYNCREST AVE
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-1633
Mailing Address - Country:US
Mailing Address - Phone:201-475-8217
Mailing Address - Fax:
Practice Address - Street 1:5-06 LYNCREST AVE
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-1633
Practice Address - Country:US
Practice Address - Phone:201-475-8217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00838300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ057842TJJMedicare ID - Type Unspecified