Provider Demographics
NPI:1922350107
Name:NUGENT, MATTHEW JAMES
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JAMES
Last Name:NUGENT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1945 EASTCHESTER RD
Mailing Address - Street 2:APT. 15F
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-2105
Mailing Address - Country:US
Mailing Address - Phone:646-479-5367
Mailing Address - Fax:
Practice Address - Street 1:44 COURT ST
Practice Address - Street 2:SUITE# 305
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4405
Practice Address - Country:US
Practice Address - Phone:718-222-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY635720163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse