Basic Information
| Provider Information | |||||||||
| NPI: | 1871515973 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KRUSE | ||||||||
| FirstName: | LAUREL | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3131 PRINCETON PIKE | ||||||||
| Address2: | BRULDERF 5, SUITE 218 | ||||||||
| City: | LAWRENCEVILLE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6098157829 | ||||||||
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| Practice Location | |||||||||
| Address1: | ONE CAPITAL WAY | ||||||||
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| City: | PENNINGTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 085345227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6093034000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2006 | ||||||||
| LastUpdateDate: | 10/27/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | MD040155E | PA | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080P0204X | MD040155E | PA | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Emergency Medicine | 2080P0204X | 25MA05302500 | NJ | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 001955942 | 05 | PA | MEDICAID | 2057808 | 05 | NJ | MEDICAID |