Healthcare Provider Details

I. General information

NPI: 1265420020
Provider Name (Legal Business Name): ELENA KRUGLYAK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELENA KRUGLYAK

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 07/31/2024
Certification Date: 07/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5130 LINTON BLVD STE B4
DELRAY BEACH FL
33484-6595
US

IV. Provider business mailing address

PO BOX 102222
ATLANTA GA
30368-2222
US

V. Phone/Fax

Practice location:
  • Phone: 561-808-0098
  • Fax: 561-496-0592
Mailing address:
  • Phone: 239-274-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME68735
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License NumberME68735
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberME68735
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: