=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356612824
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REGINALD HUGHES, MD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/16/2012
-----------------------------------------------------
Last Update Date | 01/16/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10305 LEFFERTS BLVD
-----------------------------------------------------
City | SOUTH RICHMOND HILL
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11419-2011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-862-2864
-----------------------------------------------------
Fax | 866-223-7072
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10305 LEFFERTS BLVD
-----------------------------------------------------
City | SOUTH RICHMOND HILL
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11419-2011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-862-2864
-----------------------------------------------------
Fax | 866-223-7072
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. REGINALD DOUGLAS HUGHES
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 917-862-2864
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 218738
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------