Provider Demographics
NPI:1639275001
Name:SCHUG, MARK JOHN (DPM)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:JOHN
Last Name:SCHUG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 GENESEE STREET
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501
Mailing Address - Country:US
Mailing Address - Phone:315-733-5002
Mailing Address - Fax:315-733-5003
Practice Address - Street 1:2021 GENESEE STREET
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501
Practice Address - Country:US
Practice Address - Phone:315-733-5002
Practice Address - Fax:315-733-5003
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN03287213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNO3287Medicaid
NYNO3287Medicaid
NYMS38722BMedicare ID - Type Unspecified