1003259052 NPI number — DR. JILLIAN LEE GUGINO M.D.

Table of content: DR. JILLIAN LEE GUGINO M.D. (NPI 1003259052)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003259052 NPI number — DR. JILLIAN LEE GUGINO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUGINO
Provider First Name:
JILLIAN
Provider Middle Name:
LEE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KENT
Provider Other First Name:
JILLIAN
Provider Other Middle Name:
LEE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1003259052
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1305 WALT WHITMAN RD, SUITE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MELVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11747
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-836-7510
Provider Business Mailing Address Fax Number:
716-832-3540

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
NIAGARA FALLS MEMORIAL MEDICAL CENTER
Provider Second Line Business Practice Location Address:
621 10TH ST
Provider Business Practice Location Address City Name:
NIAGARA FALLS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-836-7510
Provider Business Practice Location Address Fax Number:
716-832-3540
Provider Enumeration Date:
04/09/2013

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: 207L00000X , with the licence number:  292473 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207L00000X , with the licence number: 125-064315 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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