Doctor Name: | DR. IVAN THOMAS KROHN |
NPI Number: | 1467429258 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 25MA03609800 |
Business Practice Address: | 5521 Westfield Ave Pennsauken, NJ - 081101820 |
Business Phone Number: | 8566634060 |
Business Fax Number: | 8566637530 |
Mailing Address: | 5521 Westfield Ave, PENNSAUKEN |
State: | NJ |
Postal Code: | 081101820 |
Phone Number: | 8566634060 |
Fax Number: | 8566637530 |
NPI Enumeration Date: | 03/01/2006 |
NPI Last Update Date: | 04/21/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 25MA03609800 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |