Provider Demographics
NPI:1831641554
Name:KROLL MEDICAL GROUP INC
Entity Type:Organization
Organization Name:KROLL MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SPENCER
Authorized Official - Middle Name:D
Authorized Official - Last Name:KROLL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-775-8605
Mailing Address - Street 1:25 KILMER DR
Mailing Address - Street 2:BLDG 3, SUITE 215
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751-1564
Mailing Address - Country:US
Mailing Address - Phone:732-591-8840
Mailing Address - Fax:732-591-2822
Practice Address - Street 1:25 KILMER DR
Practice Address - Street 2:BLDG 3, SUITE 215
Practice Address - City:MORGANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07751-1564
Practice Address - Country:US
Practice Address - Phone:732-591-8840
Practice Address - Fax:732-591-2822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-28
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA71411207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty