Provider Demographics
NPI:1205187424
Name:HUDSON VALLEY CONCIERGE SERVICE
Entity Type:Organization
Organization Name:HUDSON VALLEY CONCIERGE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICAH
Authorized Official - Middle Name:JAMAL
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-594-2943
Mailing Address - Street 1:10 HUDSON LN
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:NY
Mailing Address - Zip Code:12528-1821
Mailing Address - Country:US
Mailing Address - Phone:845-518-4827
Mailing Address - Fax:845-691-6081
Practice Address - Street 1:10 HUDSON LN
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:NY
Practice Address - Zip Code:12528-1821
Practice Address - Country:US
Practice Address - Phone:845-518-4827
Practice Address - Fax:845-691-6081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY992089481305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization