Provider Demographics
NPI:1154673572
Name:KRULIS, LAUREN JADE
Entity Type:Individual
Prefix:MISS
First Name:LAUREN
Middle Name:JADE
Last Name:KRULIS
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 1:31 SAINT MARKS PL APT 1
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-7818
Mailing Address - Country:US
Mailing Address - Phone:702-690-8234
Mailing Address - Fax:
Practice Address - Street 1:COLUMBUS CIRCLE @ 60TH STREET 1841 BROADWAY SUITE 1100
Practice Address - Street 2:
Practice Address - City:NY
Practice Address - State:NY
Practice Address - Zip Code:10023
Practice Address - Country:US
Practice Address - Phone:212-355-5550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP85711225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist