=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801984927
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID ARNOLD KRULEE M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/11/2006
-----------------------------------------------------
Last Update Date | 01/21/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1062 BARNES ROAD #207
-----------------------------------------------------
City | WALLINGFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06492-4206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-265-4600
-----------------------------------------------------
Fax | 815-717-7564
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 39 HARWICH LANE
-----------------------------------------------------
City | WEST HARTFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06117-2756
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-573-3833
-----------------------------------------------------
Fax | 815-717-7564
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0804X
-----------------------------------------------------
Taxonomy Name | Child & Adolescent Psychiatry Physician
-----------------------------------------------------
License Number | 027637
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------