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General NPI Number Information
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NPI Number | 1093348492
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Entity Type | Organization
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Legal Business Name | MICHAEL OTUGH NP IN ADULT HEALTH PC
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Dates
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Enumeration Date | 02/13/2020
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Last Update Date | 02/13/2020
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Provider Practice Location Address
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Address Line | 9 SAGAMORE LN
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City | DIX HILLS
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State | NY
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Zip | 11746-6013
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Country | US
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Telephone | 646-229-5742
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Fax |
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Provider Business Mailing Address
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Address Line | 9 SAGAMORE LN
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City | DIX HILLS
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State | NY
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Zip | 11746-6013
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Country | US
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Telephone | 646-229-5742
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MICHAEL OTUGH
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Credential | NP
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Telephone | 646-229-5742
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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