Healthcare Provider Details

I. General information

NPI: 1619292422
Provider Name (Legal Business Name): D HUGO AND ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2010
Last Update Date: 04/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 WOODSIDE AVE
BROADALBIN NY
12025-2252
US

IV. Provider business mailing address

130 WOODSIDE AVE
BROADALBIN NY
12025-2252
US

V. Phone/Fax

Practice location:
  • Phone: 518-487-8675
  • Fax: 518-883-3817
Mailing address:
  • Phone: 518-487-8675
  • Fax: 518-883-3817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number005543
License Number StateOK

VIII. Authorized Official

Name: MR. DAVID A. HUGO
Title or Position: PRESIDENT
Credential: CEAP CPP SAP BCSCR
Phone: 15184878675