Provider Demographics
NPI:1306041009
Name:HUGO, JONATHAN L (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:L
Last Name:HUGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:425 EAST 61ST STREET
Mailing Address - Street 2:NYP/WEILL CORNELL, 12TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065
Mailing Address - Country:US
Mailing Address - Phone:646-962-2399
Mailing Address - Fax:646-962-0139
Practice Address - Street 1:140 SYLVAN AVE STE 213
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD CLIFFS
Practice Address - State:NJ
Practice Address - Zip Code:07632-2559
Practice Address - Country:US
Practice Address - Phone:551-444-2407
Practice Address - Fax:646-962-0139
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY257748207RE0101X
NJ25MA09166100207RE0101X
MO2007014950207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0866571Medicaid