Provider Demographics
NPI:1093056897
Name:KRUGOLETS, MARINA (SLP)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:KRUGOLETS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:288 BAY 38TH ST
Mailing Address - Street 2:APT 6M
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-6552
Mailing Address - Country:US
Mailing Address - Phone:646-361-6148
Mailing Address - Fax:
Practice Address - Street 1:288 BAY 38TH ST
Practice Address - Street 2:APT 6M
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-6552
Practice Address - Country:US
Practice Address - Phone:646-361-6148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-05
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist