Basic Information
| Provider Information | |||||||||
| NPI: | 1316928310 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STRUGAR | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 CHASE PKWY | ||||||||
| Address2: | |||||||||
| City: | WATERBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067083346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037556677 | ||||||||
| FaxNumber: | 2037557166 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 CHASE PKWY | ||||||||
| Address2: | |||||||||
| City: | WATERBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067083346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037556677 | ||||||||
| FaxNumber: | 2037557166 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2005 | ||||||||
| LastUpdateDate: | 10/28/2016 | ||||||||
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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 | 207T00000X | 034427 | CT | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | 140000167 | 01 | CT | MEDICARE ID - UNSPECIFIED | OTHER | 001344275 | 05 | CT | MEDICAID |