1386815348 NPI number — JANE KUGACZEWSKI, MD PEDICATRIC SURGERY P.C.

Table of content: DR. MATTHEW TODD WARREN DO (NPI 1215928627)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386815348 NPI number — JANE KUGACZEWSKI, MD PEDICATRIC SURGERY P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JANE KUGACZEWSKI, MD PEDICATRIC SURGERY P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386815348
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8A OLD FIELD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SETAUKET
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11733-2280
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-689-5695
Provider Business Mailing Address Fax Number:
631-689-3073

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2500 RTE 347
Provider Second Line Business Practice Location Address:
BLDG 16B, SUITE 62
Provider Business Practice Location Address City Name:
STONY BROOK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11790-2555
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-689-5695
Provider Business Practice Location Address Fax Number:
631-689-3073
Provider Enumeration Date:
03/18/2008

Additional Information

Authorized Official

Authorized Official Last Name:
KUGACZEWSKI
Authorized Official First Name:
JANE
Authorized Official Middle Name:
Authorized Official Title or Position:
PEDIATRIC SURGEON
Authorized Official Telephone Number:
631-689-5695

Provider Taxonomy Codes

  • Taxonomy code: 2086S0120X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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