1821239328 NPI number — HUDSON MEDICAL SERVICES PC

Table of content: (NPI 1821239328)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821239328 NPI number — HUDSON MEDICAL SERVICES PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HUDSON MEDICAL SERVICES 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:
1821239328
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/14/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 503
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LARCHMONT
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10538-0503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-656-0142
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
175 MEMORIAL HWY STE 2-6
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW ROCHELLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10801-5640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-355-4500
Provider Business Practice Location Address Fax Number:
914-355-5397
Provider Enumeration Date:
03/12/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LIPTON
Authorized Official First Name:
KYLE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
917-656-0142

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  208757 , 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: 02622791 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".