Basic Information
| Provider Information | |||||||||
| NPI: | 1467054817 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HUGHES | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | DAVID | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 900 ROUTE 9 N STE 410 | ||||||||
| Address2: | |||||||||
| City: | WOODBRIDGE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070951003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2018017141 | ||||||||
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| Practice Location | |||||||||
| Address1: | 300 CREEK CROSSING BLVD STE 308 | ||||||||
| Address2: | |||||||||
| City: | HAINESPORT | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080362767 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6092612530 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/11/2020 | ||||||||
| LastUpdateDate: | 11/11/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 40QB00344600 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.