Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 169901 | NY |
NPI | 1578665543 |
---|---|
Provider Name | Jane T Kugaczewski |
First Address | Setauket, NY 11733-2260 |
Second Address | Mount Sinai, NY 11766-2050 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2006 |
Last Update Date | 09/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01623138 | (05) | NY |
E64079 | (02) | NY |