1093993511 NPI number — CHRISTOPHER J. KRUGER, M.D.

Table of content: (NPI 1093993511)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093993511 NPI number — CHRISTOPHER J. KRUGER, M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHRISTOPHER J. KRUGER, M.D.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093993511
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7 FOX ST
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
POUGHKEEPSIE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12601-4716
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-471-8410
Provider Business Mailing Address Fax Number:
845-471-8459

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7 FOX ST
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
POUGHKEEPSIE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12601-4716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-471-8410
Provider Business Practice Location Address Fax Number:
845-471-8459
Provider Enumeration Date:
02/06/2008

Additional Information

Authorized Official

Authorized Official Last Name:
WYLD
Authorized Official First Name:
JANICE
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRACTICE ADMIN., OFC MGR.
Authorized Official Telephone Number:
845-471-8410

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  171627 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01341928 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3C1697 . This is a "PHS HEALTHNET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 46Z011 . This is a "EMPIRE BLUE CROSS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 9668573 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 10050175 GROUP 8588 . This is a "C. D. P. H. P" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 177128 . This is a "M. V. P." identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: DUS057 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2336172 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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