Provider Demographics
NPI:1376733964
Name:HUDSON MEDICAL GROUP PLLC
Entity Type:Organization
Organization Name:HUDSON MEDICAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:ANA
Authorized Official - Middle Name:SILVIA
Authorized Official - Last Name:ANDRONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-400-7082
Mailing Address - Street 1:20 SUSSEX PL
Mailing Address - Street 2:
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-5711
Mailing Address - Country:US
Mailing Address - Phone:914-909-4522
Mailing Address - Fax:914-909-4524
Practice Address - Street 1:984 N BROADWAY
Practice Address - Street 2:SUITE 400A
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-1318
Practice Address - Country:US
Practice Address - Phone:914-909-4522
Practice Address - Fax:914-909-4524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY214836207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW25821Medicare PIN