=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730977174
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KEVEN J HUGHES
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/26/2025
-----------------------------------------------------
Last Update Date | 11/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5010 STATE HIGHWAY 30 STE 205
-----------------------------------------------------
City | AMSTERDAM
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12010-7532
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-369-7066
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 26 CRAWFORD DR
-----------------------------------------------------
City | BALLSTON LAKE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12019-2740
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-369-7066
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 034014-01
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------