Provider Demographics
NPI:1649683905
Name:DR. FUGO PLASTIC SURGERY, P.L.L.C.
Entity type:Organization
Organization Name:DR. FUGO PLASTIC SURGERY, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:FUGO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:845-565-7040
Mailing Address - Street 1:92 OLD ROUTE 9W
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-5485
Mailing Address - Country:US
Mailing Address - Phone:845-565-7040
Mailing Address - Fax:845-565-7060
Practice Address - Street 1:92 OLD ROUTE 9W
Practice Address - Street 2:SUITE 100
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553-5485
Practice Address - Country:US
Practice Address - Phone:845-565-7040
Practice Address - Fax:845-565-7060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-04
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2607052086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty