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NPI Code Detail

MEDICARE: SERGEY PUGACH

MEDICARE: SERGEY PUGACH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker00041322NY

General Provider Information

NPI Number : 1598822553
Entity Type Code : Individual
Provider Name (Legal Business Name) : SERGEY PUGACH
Provider Business Mailing Address
First Line : 1293 E 5TH ST
Second Line : APT 4A
City : BROOKLYN
State : NY
Zip : 11230-4677
Country : US
Telephone Number : 718-845-2620
Fax Number : 718-845-9380
Provider Business Practice Location Address
First Line : 10819 ROCKAWAY BLVD
Second Line :
City : SOUTH OZONE PARK
State : NY
Zip : 11420-1034
Country : US
Telephone Number : 718-845-2620
Fax Number : 718-845-9380
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/02/2007
Last Update Date : 07/08/2007

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Directions to “ SERGEY PUGACH ” Practice Location

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