Provider Demographics
NPI:1700345014
Name:HUGUES, COREY B (MT-BC)
Entity Type:Individual
Prefix:MR
First Name:COREY
Middle Name:B
Last Name:HUGUES
Suffix:
Gender:M
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 HOLMES ST APT 19
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-2586
Mailing Address - Country:US
Mailing Address - Phone:516-443-2644
Mailing Address - Fax:
Practice Address - Street 1:141 HOLMES ST APT 19
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-2586
Practice Address - Country:US
Practice Address - Phone:516-443-2644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-16
Last Update Date:2019-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
11575225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic TherapistGroup - Single Specialty