Provider Demographics
NPI:1902213069
Name:HUDSON PODIATRY LLC
Entity Type:Organization
Organization Name:HUDSON PODIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:STEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:330-655-5000
Mailing Address - Street 1:1315 CORPORATE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-4453
Mailing Address - Country:US
Mailing Address - Phone:330-655-5000
Mailing Address - Fax:330-342-9582
Practice Address - Street 1:1315 CORPORATE DR
Practice Address - Street 2:SUITE B
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-4453
Practice Address - Country:US
Practice Address - Phone:330-655-5000
Practice Address - Fax:330-342-9582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-21
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH213EP1101X
213ES0103X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5359380002Medicare NSC