Provider Demographics
NPI:1386815348
Name:JANE KUGACZEWSKI, MD PEDICATRIC SURGERY P.C.
Entity Type:Organization
Organization Name:JANE KUGACZEWSKI, MD PEDICATRIC SURGERY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:KUGACZEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-689-5695
Mailing Address - Street 1:8A OLD FIELD RD
Mailing Address - Street 2:
Mailing Address - City:SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-2280
Mailing Address - Country:US
Mailing Address - Phone:631-689-5695
Mailing Address - Fax:631-689-3073
Practice Address - Street 1:2500 RTE 347
Practice Address - Street 2:BLDG 16B, SUITE 62
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-2555
Practice Address - Country:US
Practice Address - Phone:631-689-5695
Practice Address - Fax:631-689-3073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric SurgeryGroup - Single Specialty