Provider Demographics
NPI:1649330671
Name:KRUGER, STACEY JILL (MD)
Entity type:Individual
Prefix:DR
First Name:STACEY
Middle Name:JILL
Last Name:KRUGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:600 NORTH BOULEVARD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021
Mailing Address - Country:US
Mailing Address - Phone:516-470-2020
Mailing Address - Fax:516-470-2000
Practice Address - Street 1:600 NORTH BOULEVARD
Practice Address - Street 2:SUITE 220
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021
Practice Address - Country:US
Practice Address - Phone:516-470-2020
Practice Address - Fax:516-470-2000
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85180207W00000X
NY211514207WX0110X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0110XAllopathic & Osteopathic PhysiciansOphthalmologyPediatric Ophthalmology and Strabismus Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL043826038OtherHUMANA
FL2891680OtherAETNA HMO
FL11135OtherDIMENSION HEALTH PLAN
FL2003619OtherCIGNA
FL2108536OtherFIRST HEALTH
FL265186600Medicaid
FL29061OtherBCBS
FL043826038OtherPHCS
FL29061OtherBCBS HEALTH OPTIONS/EYE MANAGEMENT
FL042834OtherNEIGHBORHOOD HEALTH
FL2352758OtherUNITED HEALTHCARE
FL7467368OtherAETNA
FL2108536OtherFIRST HEALTH
FL265186600Medicaid