Provider Demographics
NPI:1356612824
Name:REGINALD HUGHES, MD PC
Entity type:Organization
Organization Name:REGINALD HUGHES, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REGINALD
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-862-2864
Mailing Address - Street 1:10305 LEFFERTS BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11419-2011
Mailing Address - Country:US
Mailing Address - Phone:917-862-2864
Mailing Address - Fax:866-223-7072
Practice Address - Street 1:10305 LEFFERTS BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11419-2011
Practice Address - Country:US
Practice Address - Phone:917-862-2864
Practice Address - Fax:866-223-7072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-16
Last Update Date:2012-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY218738207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH61230Medicare UPIN