Provider Demographics
NPI:1861927022
Name:MLP NP IN ADULT HEALTH GROUP, P.C
Entity type:Organization
Organization Name:MLP NP IN ADULT HEALTH GROUP, P.C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:I
Authorized Official - Last Name:OTUGH
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:516-500-9905
Mailing Address - Street 1:354 HEMPSTEAD AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-2050
Mailing Address - Country:US
Mailing Address - Phone:516-500-9905
Mailing Address - Fax:516-500-9533
Practice Address - Street 1:354 HEMPSTEAD AVE STE 101
Practice Address - Street 2:
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-2050
Practice Address - Country:US
Practice Address - Phone:516-500-9905
Practice Address - Fax:516-500-9533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-25
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY307338363LA2200X
363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty