Healthcare Provider Details

I. General information

NPI: 1558678433
Provider Name (Legal Business Name): DOUGLAS LEONARD KUGEL P.A.-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2010
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 OLD ROUTE 7
BROOKFIELD CT
06804-1711
US

IV. Provider business mailing address

31 OLD ROUTE 7
BROOKFIELD CT
06804-1711
US

V. Phone/Fax

Practice location:
  • Phone: 475-253-2599
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number015493
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA8052
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2474
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: