1417289307 NPI number — MID HUDSON NEUROSURGICAL SPECIALIST, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417289307 NPI number — MID HUDSON NEUROSURGICAL SPECIALIST, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MID HUDSON NEUROSURGICAL SPECIALIST, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417289307
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/05/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
191 COUNTRY CLUB RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOPEWELL JUNCTION
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12533-6217
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-483-1222
Provider Business Mailing Address Fax Number:
845-483-1224

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 WEBSTER AVE
Provider Second Line Business Practice Location Address:
SUITE 307
Provider Business Practice Location Address City Name:
POUGHKEEPSIE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12601-1361
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-483-1222
Provider Business Practice Location Address Fax Number:
845-483-1224
Provider Enumeration Date:
02/03/2010

Additional Information

Authorized Official

Authorized Official Last Name:
CHO
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
HYUN CHUL
Authorized Official Title or Position:
SOLE PROPRIETOR
Authorized Official Telephone Number:
845-483-1222

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  200446 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2026 www.npivalidator.com