Provider Demographics
NPI:1265420020
Name:KRUGLYAK, ELENA (MD)
Entity type:Individual
Prefix:DR
First Name:ELENA
Middle Name:
Last Name:KRUGLYAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELENA
Other - Middle Name:
Other - Last Name:KRUGLYAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 102222
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2222
Mailing Address - Country:US
Mailing Address - Phone:239-274-8200
Mailing Address - Fax:
Practice Address - Street 1:5130 LINTON BLVD STE B4
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6595
Practice Address - Country:US
Practice Address - Phone:561-808-0098
Practice Address - Fax:561-496-0592
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68735174400000X, 207RH0000X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No174400000XOther Service ProvidersSpecialist
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264956000Medicaid
FL27290OtherBCBS
FL5475027OtherAETNA
FL252889OtherAVMED
FLDELRAY456OtherRR MEDICARE
FL102794200Medicaid
FLP954880OtherOPTIMUM
FL1255024OtherWELLCARE
FL6550599OtherCIGNA
FL6664OtherDIMENSION HEALTH
FLQMP000003849305OtherMOLINA
FLP1001984OtherFREEDOM
FL6550599OtherCIGNA
FL27290YMedicare PIN