Provider Demographics
NPI:1033324116
Name:KRUGOLETS, LEONID (PT)
Entity Type:Individual
Prefix:
First Name:LEONID
Middle Name:
Last Name:KRUGOLETS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 E 3RD ST
Mailing Address - Street 2:UNIT 328
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-5356
Mailing Address - Country:US
Mailing Address - Phone:718-714-4315
Mailing Address - Fax:
Practice Address - Street 1:445 LENOX RD
Practice Address - Street 2:BOX 30
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2017
Practice Address - Country:US
Practice Address - Phone:718-270-2811
Practice Address - Fax:718-270-1247
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022067225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist