MEDICARE: DR. JONATHAN L. HUGO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	257748	NY
2	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	25MA09166100	NJ
3	207R00000X	Internal Medicine Physician	2007014950	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306041009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN L. HUGO M.D.

Provider Business Mailing Address
First Line	:	425 EAST 61ST STREET
Second Line	:	NYP/WEILL CORNELL, 12TH FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10065
Country	:	US
Telephone Number	:	646-962-2399
Fax Number	:	646-962-0139

Provider Business Practice Location Address
First Line	:	140 SYLVAN AVE STE 213
Second Line	:
City	:	ENGLEWOOD CLIFFS
State	:	NJ
Zip	:	07632-2559
Country	:	US
Telephone Number	:	551-444-2407
Fax Number	:	646-962-0139

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2007
Last Update Date	:	12/04/2023

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