Provider Demographics
NPI:1760659528
Name:PIKUS, IGOR (MD)
Entity Type:Individual
Prefix:
First Name:IGOR
Middle Name:
Last Name:PIKUS
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:PO BOX 26960
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-6960
Mailing Address - Country:US
Mailing Address - Phone:631-444-2754
Mailing Address - Fax:631-444-6031
Practice Address - Street 1:STONY BROOK UNIVERSITY HOSPITAL
Practice Address - Street 2:DEPT ANESTHESIOLOGY - HSC4
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8480
Practice Address - Country:US
Practice Address - Phone:631-444-2976
Practice Address - Fax:631-444-2907
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08404200207L00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program