Provider Demographics
NPI:1104842756
Name:HUDSON VALLEY MEDICAL GROUP, PLLC
Entity Type:Organization
Organization Name:HUDSON VALLEY MEDICAL GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WIJAYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RATNATHICAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-788-9719
Mailing Address - Street 1:211 S DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566-3611
Mailing Address - Country:US
Mailing Address - Phone:914-788-9719
Mailing Address - Fax:914-788-9719
Practice Address - Street 1:211 S DIVISION ST
Practice Address - Street 2:
Practice Address - City:PEEKSKILL
Practice Address - State:NY
Practice Address - Zip Code:10566-3611
Practice Address - Country:US
Practice Address - Phone:914-788-9719
Practice Address - Fax:914-788-9719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWEJ161Medicare ID - Type UnspecifiedMEDICARE