Provider Demographics
NPI:1528034105
Name:KUGLER, STEPHANIE (NUTRITIONIST)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:KUGLER
Suffix:
Gender:F
Credentials:NUTRITIONIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 5TH AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-3340
Mailing Address - Country:US
Mailing Address - Phone:518-274-0476
Mailing Address - Fax:518-274-0497
Practice Address - Street 1:2001 5TH AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-3340
Practice Address - Country:US
Practice Address - Phone:518-274-0476
Practice Address - Fax:518-274-0497
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003874133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY79898OtherGHIHMO
NY8099807OtherGHI
NY706656Medicare UPIN