Organization
JANE T KUGACZEWSKI MD PEDIATRIC SURGERY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JANE T KUGACZEWSKI MD (PRESIDENT)
(631) 689-5695
Entity
Organization
Contact information
Practice address
2500 NESCONSET HWY, BLDG 16B SUITE 62, STONY BROOK, NY 11790-2555
(631) 689-5695
(631) 689-3073
Mailing address
8A OLD FIELD RD, SETAUKET, NY 11733-2280
(631) 689-5695
(631) 689-3073
Taxonomy
Speciality
Code
Description
License number
State
2086S0120X
Pediatric Surgery Physician
Primary
169901
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01623138
—
NY
Enumeration date
11/26/2012
Last updated
11/26/2012
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