Provider Demographics
NPI:1003259052
Name:GUGINO, JILLIAN LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:JILLIAN
Middle Name:LEE
Last Name:GUGINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JILLIAN
Other - Middle Name:LEE
Other - Last Name:KENT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1305 WALT WHITMAN RD, SUITE 300
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747
Mailing Address - Country:US
Mailing Address - Phone:716-836-7510
Mailing Address - Fax:716-832-3540
Practice Address - Street 1:NIAGARA FALLS MEMORIAL MEDICAL CENTER
Practice Address - Street 2:621 10TH ST
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14301
Practice Address - Country:US
Practice Address - Phone:716-836-7510
Practice Address - Fax:716-832-3540
Is Sole Proprietor?:No
Enumeration Date:2013-04-09
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY292473207L00000X
IL125-064315207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology