| Crescent Internal Medicine Group, Llc | |
|
29 The Crescent Montclair NJ 07042-2636 | |
| (973) 783-0800 | |
| (973) 744-1274 |
| Full Name | Crescent Internal Medicine Group, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 29 The Crescent, Montclair, New Jersey |
| Authorized Official Name and Position | Edward Todd Krupp (OWNER/PHYSICIAN) |
| Authorized Official Contact | 9737830800 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Crescent Internal Medicine Group, Llc 29 The Crescent Montclair NJ 07042-2636 Ph: (973) 783-0800 | Crescent Internal Medicine Group, Llc 29 The Crescent Montclair NJ 07042-2636 Ph: (973) 783-0800 |
| NPI Number | 1790886885 |
|---|---|
| Provider Enumeration Date | 09/25/2006 |
| Last Update Date | 04/20/2008 |
| Medicare PECOS PAC ID | 8628067931 |
|---|---|
| Medicare Enrollment ID | O20040511001220 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790886885 | NPI | - | NPPES |
| P00059104 | Other | NJ | RAILROAD MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 25MB071292 (New Jersey) | Primary |
| Provider Name | Edward Todd Krupp |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1760583868 PECOS PAC ID: 0042118119 Enrollment ID: I20031229000116 |
| Provider Name | Maria Abigail Pama |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013551092 PECOS PAC ID: 6406280684 Enrollment ID: I20191220001533 |
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