Provider Demographics
NPI:1407056534
Name:FUGO, JONATHAN ROBIN (DO)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:ROBIN
Last Name:FUGO
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Gender:M
Credentials:DO
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Mailing Address - Street 1:92 OLD ROUTE 9W
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-5485
Mailing Address - Country:US
Mailing Address - Phone:845-565-7040
Mailing Address - Fax:845-565-7060
Practice Address - Street 1:21 LAUREL AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:CORNWALL
Practice Address - State:NY
Practice Address - Zip Code:12518-1469
Practice Address - Country:US
Practice Address - Phone:845-237-7040
Practice Address - Fax:845-237-7060
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2015-12-23
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Provider Licenses
StateLicense IDTaxonomies
NY260705208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03372070Medicaid
NY03372070Medicaid