Provider Demographics
NPI:1760583868
Name:KRUPP, EDWARD TODD (DO)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:TODD
Last Name:KRUPP
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:98 PARK ST
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-2929
Mailing Address - Country:US
Mailing Address - Phone:973-783-0800
Mailing Address - Fax:973-744-1274
Practice Address - Street 1:29 THE CRESCENT
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2636
Practice Address - Country:US
Practice Address - Phone:973-783-0800
Practice Address - Fax:973-744-1274
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB071292207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP00059104OtherRAILROAD MEDICARE
NJ200019307OtherBLUE CROSS BLUE SHEILD
H78008Medicare UPIN