Provider Demographics
NPI:1417289307
Name:MID HUDSON NEUROSURGICAL SPECIALIST, PC
Entity Type:Organization
Organization Name:MID HUDSON NEUROSURGICAL SPECIALIST, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:HYUN CHUL
Authorized Official - Last Name:CHO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-483-1222
Mailing Address - Street 1:191 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL JUNCTION
Mailing Address - State:NY
Mailing Address - Zip Code:12533-6217
Mailing Address - Country:US
Mailing Address - Phone:845-483-1222
Mailing Address - Fax:845-483-1224
Practice Address - Street 1:1 WEBSTER AVE
Practice Address - Street 2:SUITE 307
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-1361
Practice Address - Country:US
Practice Address - Phone:845-483-1222
Practice Address - Fax:845-483-1224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-03
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2004462084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100023736Medicare PIN