Active NPI
Peter Joseph Kruy, M.D.
- Dermatology Physician
- Waltham, MA
National Provider Identifier
1932392495
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- 72084
- Practice address
- 411 Waverley Oaks Rd
Suite 133
Waltham, MA 02452-8448 - Phone
- (781) 899-7546
- Fax
- (781) 899-9922
- NPI assigned
- Aug 19, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | 72084 | MA | Primary |
Addresses
Primary practice location
411 Waverley Oaks Rd
Suite 133
Waltham, MA 02452-8448
Mailing address
3 Crown Point Rd
Sudbury, MA 01776-1609
Phone (978) 443-1409
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 72084 | MA | MD | Dermatology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1187481600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1187481600000",
"number": "1932392495",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3 CROWN POINT RD",
"city": "SUDBURY",
"state": "MA",
"postal_code": "017761609",
"telephone_number": "978-443-1409",
"fax_number": "781-899-9922"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "411 WAVERLEY OAKS RD",
"address_2": "SUITE 133",
"city": "WALTHAM",
"state": "MA",
"postal_code": "024528448",
"telephone_number": "781-899-7546",
"fax_number": "781-899-9922"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KRUY",
"first_name": "PETER",
"middle_name": "JOSEPH",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-08-19",
"last_updated": "2007-08-19",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "MA",
"license": "72084",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waltham, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.