Provider Demographics
NPI:1457598112
Name:CHRISTOPHER B. KRUSE, M.D., LLC
Entity Type:Organization
Organization Name:CHRISTOPHER B. KRUSE, M.D., LLC
Other - Org Name:DERMATOLOGY AND SKIN CANCER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:KRUSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-641-4511
Mailing Address - Street 1:55 N GILBERT ST
Mailing Address - Street 2:SUITE 1201
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-4904
Mailing Address - Country:US
Mailing Address - Phone:732-747-5500
Mailing Address - Fax:732-747-1212
Practice Address - Street 1:55 N GILBERT ST
Practice Address - Street 2:SUITE 1201
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07701-4904
Practice Address - Country:US
Practice Address - Phone:732-747-5500
Practice Address - Fax:732-747-1212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-15
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07084600207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty