Healthcare Provider Details

I. General information

NPI: 1629150388
Provider Name (Legal Business Name): JAY KUGLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 12/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 NORTHERN BLVD SUITE 203
GREAT NECK NY
11021-5100
US

IV. Provider business mailing address

560 NORTHERN BLVD SUITE 203
GREAT NECK NY
11021-5100
US

V. Phone/Fax

Practice location:
  • Phone: 516-482-0600
  • Fax: 516-829-9674
Mailing address:
  • Phone: 516-482-0600
  • Fax: 516-829-9674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number143213
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: