Provider Demographics
NPI:1619063922
Name:KROL, HALINA KRUTAK (MD, LLC)
Entity Type:Individual
Prefix:MRS
First Name:HALINA
Middle Name:KRUTAK
Last Name:KROL
Suffix:
Gender:F
Credentials:MD, LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 BRIGHTON ROAD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012
Mailing Address - Country:US
Mailing Address - Phone:973-777-9950
Mailing Address - Fax:973-778-2763
Practice Address - Street 1:164 BRIGHTON ROAD
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07012
Practice Address - Country:US
Practice Address - Phone:973-777-9950
Practice Address - Fax:973-778-2763
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05177800207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3435601Medicaid
E29943Medicare UPIN
NJ583853Medicare ID - Type Unspecified