Provider Demographics
NPI:1902859440
Name:KRUGLYAKOVA, GALINA (OD)
Entity Type:Individual
Prefix:DR
First Name:GALINA
Middle Name:
Last Name:KRUGLYAKOVA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2421 OCEAN AVE
Mailing Address - Street 2:APT 5B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-3566
Mailing Address - Country:US
Mailing Address - Phone:718-934-4625
Mailing Address - Fax:
Practice Address - Street 1:3511 QUENTIN RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-4230
Practice Address - Country:US
Practice Address - Phone:718-377-1021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006784152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02601843Medicaid
NYC353G1Medicare PIN
NY02601843Medicaid