Healthcare Provider Details

I. General information

NPI: 1366430217
Provider Name (Legal Business Name): RICHARD KRUGLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 HEMPSTEAD TPKE
UNIONDALE NY
11553-1111
US

IV. Provider business mailing address

165 LEFFERTS RD
WOODMERE NY
11598-1347
US

V. Phone/Fax

Practice location:
  • Phone: 631-608-5620
  • Fax: 631-396-0382
Mailing address:
  • Phone: 914-949-1199
  • Fax: 914-949-1245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number132755-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number132755-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: