Provider Demographics
NPI:1578665543
Name:KUGACZEWSKI, JANE T (MD)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:T
Last Name:KUGACZEWSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8A OLD FIELD RD
Mailing Address - Street 2:
Mailing Address - City:SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-2260
Mailing Address - Country:US
Mailing Address - Phone:631-689-5695
Mailing Address - Fax:631-689-3073
Practice Address - Street 1:701 ROUTE 25A STE A5
Practice Address - Street 2:
Practice Address - City:MOUNT SINAI
Practice Address - State:NY
Practice Address - Zip Code:11766-2050
Practice Address - Country:US
Practice Address - Phone:631-689-5695
Practice Address - Fax:631-689-3073
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1699012086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01623138Medicaid
NYE64079Medicare UPIN
NY5A3141Medicare PIN