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General NPI Number Information
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NPI Number | 1487998886
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Entity Type | Organization
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Legal Business Name | JANE T KUGACZEWSKI MD PEDIATRIC SURGERY PC
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Dates
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Enumeration Date | 11/26/2012
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Last Update Date | 11/26/2012
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Provider Practice Location Address
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Address Line | 2500 NESCONSET HWY BLDG 16B SUITE 62
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City | STONY BROOK
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State | NY
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Zip | 11790-2555
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Country | US
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Telephone | 631-689-5695
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Fax | 631-689-3073
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Provider Business Mailing Address
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Address Line | 8A OLD FIELD RD
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City | SETAUKET
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State | NY
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Zip | 11733-2280
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Country | US
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Telephone | 631-689-5695
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Fax | 631-689-3073
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Authorized Official
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Title or Position | PRESIDENT
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Name | JANE T KUGACZEWSKI
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Credential | MD
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Telephone | 631-689-5695
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0120X
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Taxonomy Name | Pediatric Surgery Physician
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License Number | 169901
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License Number State | NY
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