Provider Demographics
NPI:1225214968
Name:STEPHEN J KRULJAC, D.P.M., P.C.
Entity Type:Organization
Organization Name:STEPHEN J KRULJAC, D.P.M., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:KRULJAC
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:412-461-1108
Mailing Address - Street 1:495 EAST WATERFRONT DRIVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:HOMESTEAD
Mailing Address - State:PA
Mailing Address - Zip Code:15120-1151
Mailing Address - Country:US
Mailing Address - Phone:412-461-1108
Mailing Address - Fax:412-461-5490
Practice Address - Street 1:495 EAST WATERFRONT DRIVE
Practice Address - Street 2:SUITE 230
Practice Address - City:HOMESTEAD
Practice Address - State:PA
Practice Address - Zip Code:15120-1151
Practice Address - Country:US
Practice Address - Phone:412-461-1108
Practice Address - Fax:412-461-5490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002458L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100960XXTOtherMC GROUP PROVIDER NUMBER
PA1225214968OtherMC GROUP NPI NUMBER
PA1225214968OtherINDIVIDUAL NPI NUMBER
PA100960OtherMEDICARE LEGACY NUMBER
PA480009776OtherRAILROAD MEDICARE
PA0009128330001Medicaid
PAT28597Medicare UPIN
PA480009776OtherRAILROAD MEDICARE