Provider Demographics
NPI:1366723926
Name:MUGUTSO, DENMARK (MS CNIM)
Entity type:Individual
Prefix:
First Name:DENMARK
Middle Name:
Last Name:MUGUTSO
Suffix:
Gender:M
Credentials:MS CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1991 MARCUS AVE
Mailing Address - Street 2:SUITE 108 / NEUROPHYSIOLOGY
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-2057
Mailing Address - Country:US
Mailing Address - Phone:804-868-8011
Mailing Address - Fax:516-442-1897
Practice Address - Street 1:1991 MARCUS AVE
Practice Address - Street 2:SUITE 108 / NEUROPHYSIOLOGY
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-2057
Practice Address - Country:US
Practice Address - Phone:804-868-8011
Practice Address - Fax:516-442-1897
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA916246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic