Individual
DR. MARK J JAGUST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2835 MIDDLE COUNTRY RD, LAKE GROVE, NY 11755-2105
(631) 467-3564
(631) 471-2236
Mailing address
2835 MIDDLE COUNTRY RD, LAKE GROVE, NY 11755-2105
(631) 467-3564
(631) 471-2236
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
178630
NY
Other
Enumeration date
06/09/2006
Last updated
08/10/2010
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