Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251C2600X | Cardiopulmonary | 40QA00216700 | NJ |
NPI | 1720154024 |
---|---|
Provider Name | Phyllis G Krug |
First Address | Teaneck, NJ 07666-2820 |
Second Address | Teaneck, NJ 07666-2820 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2006 |
Last Update Date | 20/09/2011 |