Provider Demographics
NPI:1093348492
Name:MICHAEL OTUGH NP IN ADULT HEALTH PC
Entity Type:Organization
Organization Name:MICHAEL OTUGH NP IN ADULT HEALTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:OTUGH
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:646-229-5742
Mailing Address - Street 1:9 SAGAMORE LN
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-6013
Mailing Address - Country:US
Mailing Address - Phone:646-229-5742
Mailing Address - Fax:
Practice Address - Street 1:9 SAGAMORE LN
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-6013
Practice Address - Country:US
Practice Address - Phone:646-229-5742
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-13
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty