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Contact Information

MARK J JAGUST, MD
2835 MIDDLE COUNTRY RD
LAKE GROVE, NY11755-2105
 Phone: 631-467-3564
 Fax: 631-471-2236
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Family Medicine

207Q00000X 08 Physician/Family Practice
Indicates primary specialty

NPI Profile & details for MARK J JAGUST · (Male)

NPI Number 1467493494
Status Active
Credentials MD
Entity Individual
Enumeration date 06/09/2006
Last updated 08/10/2010 - About 16 years ago
Sole proprietor 1 Yes
Identifiers
  • NY License # 178630
Hospital affiliation(s)
  • JOHN T MATHER MEMORIAL HOSPITAL OF PORT JEFFERSON - (Acute Care)
    75 NORTH COUNTRY ROAD
    PORT JEFFERSON, NY 11777
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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