Provider Demographics
NPI:1477368520
Name:KRUPOVLYANSKIY, LEONID
Entity type:Individual
Prefix:
First Name:LEONID
Middle Name:
Last Name:KRUPOVLYANSKIY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3354 E BROAD ST STE A
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-1031
Mailing Address - Country:US
Mailing Address - Phone:718-915-0392
Mailing Address - Fax:614-308-0102
Practice Address - Street 1:3354 E BROAD ST STE A
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-1031
Practice Address - Country:US
Practice Address - Phone:718-915-0392
Practice Address - Fax:614-308-0102
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-07
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center