1255412409 NPI number — ISAAC ZINOVY PUGACH M.D.

Table of content: ISAAC ZINOVY PUGACH M.D. (NPI 1255412409)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255412409 NPI number — ISAAC ZINOVY PUGACH M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PUGACH
Provider First Name:
ISAAC
Provider Middle Name:
ZINOVY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PUGACH
Provider Other First Name:
ZINOVY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1255412409
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/19/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
660 N CENTRAL EXPY STE 640
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLANO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75074-6856
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-792-7777
Provider Business Mailing Address Fax Number:
469-969-0090

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
660 N CENTRAL EXPY STE 640
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLANO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75074-6856
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-792-7777
Provider Business Practice Location Address Fax Number:
469-969-0090
Provider Enumeration Date:
10/17/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  M4454 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)