Healthcare Provider Details

I. General information

NPI: 1164566915
Provider Name (Legal Business Name): PHYLLIS E HUGHES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1114 GOFFLE RD
HAWTHORNE NJ
07506-2014
US

IV. Provider business mailing address

90 PHELPS AVE
BERGENFIELD NJ
07621-1312
US

V. Phone/Fax

Practice location:
  • Phone: 973-427-7676
  • Fax: 973-427-7476
Mailing address:
  • Phone: 973-427-7676
  • Fax: 973-427-7476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NN04244200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: