Provider Demographics
NPI:1033354014
Name:MCKENZIE, HUGH LA (NPP)
Entity Type:Individual
Prefix:
First Name:HUGH
Middle Name:LA
Last Name:MCKENZIE
Suffix:
Gender:M
Credentials:NPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2074
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10949-8574
Mailing Address - Country:US
Mailing Address - Phone:845-610-5198
Mailing Address - Fax:845-259-1223
Practice Address - Street 1:225 S PLANK RD STE 2
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-2693
Practice Address - Country:US
Practice Address - Phone:845-610-5198
Practice Address - Fax:845-259-1223
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-05
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF401498363LP0808X
NY460673-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03722332Medicaid