Provider Demographics
NPI:1104886076
Name:NUGENT, EILEEN MARIE (DO)
Entity type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:MARIE
Last Name:NUGENT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:344 SAN GABRIEL DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14610-2903
Mailing Address - Country:US
Mailing Address - Phone:585-703-0904
Mailing Address - Fax:585-348-9315
Practice Address - Street 1:125 SULLYS TRL STE 5A
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-4566
Practice Address - Country:US
Practice Address - Phone:585-348-9315
Practice Address - Fax:585-348-9315
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY225935207Q00000X, 204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02357555Medicaid
NYH73768Medicare UPIN
NYRA8220Medicare PIN