Provider Demographics
NPI:1730460171
Name:INNOVATIVE PSYCHIATRICARE PC
Entity type:Organization
Organization Name:INNOVATIVE PSYCHIATRICARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:KRUGLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-569-1027
Mailing Address - Street 1:165 LEFFERTS RD
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1347
Mailing Address - Country:US
Mailing Address - Phone:516-569-1027
Mailing Address - Fax:
Practice Address - Street 1:165 LEFFERTS RD
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-1347
Practice Address - Country:US
Practice Address - Phone:516-569-1027
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-30
Last Update Date:2017-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1327552084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty