Provider Demographics
NPI:1033124821
Name:HUDSON NEUROLOGY AND NEUROPHYSIOLOGY PC
Entity Type:Organization
Organization Name:HUDSON NEUROLOGY AND NEUROPHYSIOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DOROTHEA
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLIGREW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-631-3640
Mailing Address - Street 1:245 N BROADWAY STE 102
Mailing Address - Street 2:
Mailing Address - City:SLEEPY HOLLOW
Mailing Address - State:NY
Mailing Address - Zip Code:10591-2657
Mailing Address - Country:US
Mailing Address - Phone:914-631-6888
Mailing Address - Fax:914-631-2700
Practice Address - Street 1:245 N BROADWAY STE 102
Practice Address - Street 2:
Practice Address - City:SLEEPY HOLLOW
Practice Address - State:NY
Practice Address - Zip Code:10591-2657
Practice Address - Country:US
Practice Address - Phone:914-631-6888
Practice Address - Fax:914-631-2700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2052302084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2C6986OtherHEALTHNET
NYP1045613OtherOXFORD
NY2C6986OtherHEALTHNET
NYG75860Medicare UPIN