1295720647 NPI number — DAVID L HODES MD

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 1295720647 NPI number — DAVID L HODES MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HODES
Provider First Name:
DAVID
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1295720647
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/18/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 MEDICAL PARK DR
Provider Second Line Business Mailing Address:
SUITE 3
Provider Business Mailing Address City Name:
WEST NYACK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10994-1965
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-727-7733
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 MEDICAL PARK DRIVE
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
W. NYACK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10994
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-727-7733
Provider Business Practice Location Address Fax Number:
845-727-7743
Provider Enumeration Date:
09/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  1270021 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X , with the licence number: 1270021 , 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)

  • Identifier: 0018574 . This is a "GHI HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 270937303 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 040426011550 . This is a "FIDELIS MEDICAID HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0D0702 . This is a "HEALTH NET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 132995699 . This is a "HUDSON HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 172690 . This is a "ONE HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 341111 . This is a "BC BS EMPIRE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 93968209 . This is a "UHC" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 132995699 . This is a "LOCAL 1199" identifier . This identifiers is of the category "OTHER".
  • Identifier: 132995699 . This is a "MUTLIPLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 270937303 . This is a "MULTIPLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 070CZ1 . This is a "EMPIRE BC/BS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 132995699 . This is a "BEECH STREET NETWORK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 101119 . This is a "AETNA USHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 132995699 . This is a "CIGNA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 341111 . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00790276 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 127002 . This is a "LICENSE NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 132995699 . This is a "HEALTH NOW" identifier . This identifiers is of the category "OTHER".
  • Identifier: 132995699 . This is a "INDECS" identifier . This identifiers is of the category "OTHER".




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