Healthcare Provider Details

I. General information

NPI: 1578928057
Provider Name (Legal Business Name): JOHN KUGLER PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2015
Last Update Date: 12/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 E 5TH ST SUITE 115
BROOKLYN NY
11218-2403
US

IV. Provider business mailing address

7721 10TH AVE
BROOKLYN NY
11228-2341
US

V. Phone/Fax

Practice location:
  • Phone: 718-530-4042
  • Fax:
Mailing address:
  • Phone: 718-530-4042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number013466
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: