Provider Demographics
NPI:1396728895
Name:MCHUGH, MARLENE E (FNP)
Entity type:Individual
Prefix:
First Name:MARLENE
Middle Name:E
Last Name:MCHUGH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 32888
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06150-2888
Mailing Address - Country:US
Mailing Address - Phone:212-844-1416
Mailing Address - Fax:
Practice Address - Street 1:16TH STREET AT 1ST AVE
Practice Address - Street 2:BIMC DEPT PAIN MEDICINE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003
Practice Address - Country:US
Practice Address - Phone:212-844-1416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF330589363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01292424Medicaid
S45777Medicare UPIN
NY01292424Medicaid