Provider Demographics
NPI:1174859318
Name:EUGENE M.J. PUGATCH, M.D., P.A.
Entity type:Organization
Organization Name:EUGENE M.J. PUGATCH, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:MJ
Authorized Official - Last Name:PUGATCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-783-6811
Mailing Address - Street 1:4 CRESTVIEW CT
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-1702
Mailing Address - Country:US
Mailing Address - Phone:973-783-6811
Mailing Address - Fax:973-783-7748
Practice Address - Street 1:4 CRESTVIEW CT
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-1702
Practice Address - Country:US
Practice Address - Phone:973-783-6811
Practice Address - Fax:973-783-7748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-22
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ459150Medicare PIN
NJC56092Medicare UPIN