Provider Demographics
NPI:1043451883
Name:KINYUNGU, NGUGI M (MD)
Entity type:Individual
Prefix:
First Name:NGUGI
Middle Name:M
Last Name:KINYUNGU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ERICK
Other - Middle Name:N
Other - Last Name:KINYUNGU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:68 S. SERVICE RD.
Mailing Address - Street 2:STE 350
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-2358
Mailing Address - Country:US
Mailing Address - Phone:516-945-3357
Mailing Address - Fax:516-945-3131
Practice Address - Street 1:221 JERICHO TPKE
Practice Address - Street 2:NORTH SHORE UNIV HOSPITAL AT SYOSSET
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-4515
Practice Address - Country:US
Practice Address - Phone:516-496-6454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-06
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND11521207L00000X, 208VP0000X
NY270909207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine