Provider Demographics
NPI:1932526399
Name:KROUGLIAK, JUSTINE RENEE (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:JUSTINE
Middle Name:RENEE
Last Name:KROUGLIAK
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 CLARK ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07403-1311
Mailing Address - Country:US
Mailing Address - Phone:609-922-2453
Mailing Address - Fax:
Practice Address - Street 1:125 CLARK ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:NJ
Practice Address - Zip Code:07403-1311
Practice Address - Country:US
Practice Address - Phone:609-922-2453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-24
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00489000363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner