Provider Demographics
NPI:1083849954
Name:MCHUGH, KIMBERLY MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:MARIE
Last Name:MCHUGH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:454 LENOX AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10037-3320
Mailing Address - Country:US
Mailing Address - Phone:212-368-2020
Mailing Address - Fax:212-368-2029
Practice Address - Street 1:454 LENOX AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037-3320
Practice Address - Country:US
Practice Address - Phone:212-368-2020
Practice Address - Fax:212-368-2029
Is Sole Proprietor?:No
Enumeration Date:2009-05-21
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV007425-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03391504Medicaid
NY03391504Medicaid