Individual
JANE T KUGACZEWSKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
701 ROUTE 25A STE A5, MOUNT SINAI, NY 11766-2050
(631) 689-5695
(631) 689-3073
Mailing address
8A OLD FIELD RD, SETAUKET, NY 11733-2260
(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
09/01/2006
Last updated
05/09/2017
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