Provider Demographics
NPI:1225028640
Name:CUGINI, DONALD ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:ANTHONY
Last Name:CUGINI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 MECHANIC ST
Mailing Address - Street 2:STE. 102
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-1869
Mailing Address - Country:US
Mailing Address - Phone:732-530-0151
Mailing Address - Fax:732-741-3730
Practice Address - Street 1:65 MECHANIC ST
Practice Address - Street 2:STE. 102
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1869
Practice Address - Country:US
Practice Address - Phone:732-530-0151
Practice Address - Fax:732-741-3730
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA52921208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5399301Medicaid
NJ077693AJ7Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER #
NJF35799Medicare UPIN