Provider Demographics
NPI:1700855483
Name:KRUCZAY, JOY ELLEN (DPM)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:ELLEN
Last Name:KRUCZAY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 WALNUT ST
Mailing Address - Street 2:STE 101
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15901-2930
Mailing Address - Country:US
Mailing Address - Phone:814-535-3287
Mailing Address - Fax:814-535-3287
Practice Address - Street 1:244 WALNUT ST
Practice Address - Street 2:STE 101
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15901-2930
Practice Address - Country:US
Practice Address - Phone:814-535-3287
Practice Address - Fax:814-535-3287
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002867L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010147440001Medicaid
PA480022007OtherRAILROAD MEDICARE
PA0010147440001Medicaid
PA147773H1NMedicare ID - Type Unspecified