Provider Demographics
NPI:1689798969
Name:KROOG, GLENN S (MD)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:S
Last Name:KROOG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:MEMORIAL SLOAN-KETTERING CANCER CENTER
Mailing Address - Street 2:1275 YORK AVENUE
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065
Mailing Address - Country:US
Mailing Address - Phone:646-422-4313
Mailing Address - Fax:212-988-0683
Practice Address - Street 1:MEMORIAL SLOAN-KETTERING CANCER CENTER
Practice Address - Street 2:1275 YORK AVENUE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065
Practice Address - Country:US
Practice Address - Phone:646-422-4313
Practice Address - Fax:212-988-0683
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY183916207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02134247Medicaid
NY02134247Medicaid