Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | 264898 | NY |
NPI | 1053515932 |
---|---|
Provider Name | John Pugh |
First Address | Albany, NY 12208-3478 |
Second Address | Albany, NY 12208-3478 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2007 |
Last Update Date | 02/08/2019 |