Basic Information
| Provider Information | |||||||||
| NPI: | 1043451883 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KINYUNGU | ||||||||
| FirstName: | NGUGI | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | KINYUNGU | ||||||||
| OtherFirstName: | ERICK | ||||||||
| OtherMiddleName: | N | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 68 S. SERVICE RD. | ||||||||
| Address2: | STE 350 | ||||||||
| City: | MELVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117472358 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5169453357 | ||||||||
| FaxNumber: | 5169453131 | ||||||||
| Practice Location | |||||||||
| Address1: | 221 JERICHO TPKE | ||||||||
| Address2: | NORTH SHORE UNIV HOSPITAL AT SYOSSET | ||||||||
| City: | SYOSSET | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117914515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5164966454 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2009 | ||||||||
| LastUpdateDate: | 02/24/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 11521 | ND | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 270909 | NY | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP2900X | 270909 | NY | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 208VP0000X | 11521 | ND | N | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
No ID Information.