Provider Demographics
NPI:1043096753
Name:KRUGLY, OLGA
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:KRUGLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2932 BRIGHTON 12TH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-4705
Mailing Address - Country:US
Mailing Address - Phone:732-604-0190
Mailing Address - Fax:
Practice Address - Street 1:2932 BRIGHTON 12TH ST FL 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-4705
Practice Address - Country:US
Practice Address - Phone:732-604-0190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYCERTIFIED174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist