Healthcare Provider Details

I. General information

NPI: 1780623900
Provider Name (Legal Business Name): GWENDA ROBIN KUGLER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 WILLIS AVE
MINEOLA NY
11501-2620
US

IV. Provider business mailing address

PO BOX 270
MASSAPEQUA PARK NY
11762-0270
US

V. Phone/Fax

Practice location:
  • Phone: 516-294-0030
  • Fax: 516-294-0228
Mailing address:
  • Phone: 631-264-2035
  • Fax: 631-264-1418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number229459
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: