Healthcare Provider Details

I. General information

NPI: 1992837637
Provider Name (Legal Business Name): ISLAND ENDOCRINOLOGY,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 09/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 MOUNT PLEASANT RD
SMITHTOWN NY
11787-4831
US

IV. Provider business mailing address

221 MOUNT PLEASANT RD
SMITHTOWN NY
11787-4831
US

V. Phone/Fax

Practice location:
  • Phone: 631-979-9700
  • Fax: 631-265-8042
Mailing address:
  • Phone: 631-979-9700
  • Fax: 631-265-8042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID B KUGLER
Title or Position: TREASURER
Credential: D.O.
Phone: 631-979-9700