Provider Demographics
NPI:1659410934
Name:HUDSON PODIATRY ASSOCIATES, PC
Entity Type:Organization
Organization Name:HUDSON PODIATRY ASSOCIATES, PC
Other - Org Name:YORKTOWN FOOTCARE GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLOOM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:914-245-7888
Mailing Address - Street 1:2050 SAW MILL RIVER RD
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:10598-4108
Mailing Address - Country:US
Mailing Address - Phone:914-245-7888
Mailing Address - Fax:914-245-7909
Practice Address - Street 1:2050 SAW MILL RIVER RD
Practice Address - Street 2:
Practice Address - City:YORKTOWN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:10598-4108
Practice Address - Country:US
Practice Address - Phone:914-245-7888
Practice Address - Fax:914-245-7909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN-004707213ES0131X
NYN-004712213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU10277Medicare UPIN
NYU06471Medicare UPIN
NYP1W462Medicare PIN
NY5625580002Medicare NSC
NYP1W461Medicare PIN