Provider Demographics
NPI:1558391334
Name:ETTLINGER, HUGH MARSHALL (DO)
Entity Type:Individual
Prefix:DR
First Name:HUGH
Middle Name:MARSHALL
Last Name:ETTLINGER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:20 ALLAPARTUS CIR
Mailing Address - Street 2:
Mailing Address - City:OSSINING
Mailing Address - State:NY
Mailing Address - Zip Code:10562-1610
Mailing Address - Country:US
Mailing Address - Phone:914-941-7274
Mailing Address - Fax:
Practice Address - Street 1:4422 3RD AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-2545
Practice Address - Country:US
Practice Address - Phone:718-960-6517
Practice Address - Fax:718-960-3635
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY175636204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE55969Medicare UPIN
NY08F34Medicare ID - Type UnspecifiedMEDICARE ID NUMBER