Provider Demographics
NPI:1013201227
Name:HUDSON, PHILIP NORDAN JR (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:NORDAN
Last Name:HUDSON
Suffix:JR
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 W 9TH ST
Mailing Address - Street 2:SUITE 6D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-8971
Mailing Address - Country:US
Mailing Address - Phone:347-857-9039
Mailing Address - Fax:
Practice Address - Street 1:26 W 9TH ST
Practice Address - Street 2:SUITE 6D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8971
Practice Address - Country:US
Practice Address - Phone:347-857-9039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019328103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist