MEDICARE: DR. GALINA KRUGLYAKOVA OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	TUV006784	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902859440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GALINA KRUGLYAKOVA OD

Provider Business Mailing Address
First Line	:	2421 OCEAN AVE
Second Line	:	APT 5B
City	:	BROOKLYN
State	:	NY
Zip	:	11229-3566
Country	:	US
Telephone Number	:	718-934-4625
Fax Number	:

Provider Business Practice Location Address
First Line	:	3511 QUENTIN RD
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-4230
Country	:	US
Telephone Number	:	718-377-1021
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	01/31/2011

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