Healthcare Provider Details

I. General information

NPI: 1558391334
Provider Name (Legal Business Name): HUGH MARSHALL ETTLINGER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4422 3RD AVE
BRONX NY
10457-2545
US

IV. Provider business mailing address

20 ALLAPARTUS CIR
OSSINING NY
10562-1610
US

V. Phone/Fax

Practice location:
  • Phone: 718-960-6517
  • Fax: 718-960-3635
Mailing address:
  • Phone: 914-941-7274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number175636
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: