Provider Demographics
NPI:1932129459
Name:MID-HUDSON COMPREHENSIVE MEDICAL, PC
Entity Type:Organization
Organization Name:MID-HUDSON COMPREHENSIVE MEDICAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MD.
Authorized Official - Prefix:
Authorized Official - First Name:SUJATA
Authorized Official - Middle Name:
Authorized Official - Last Name:VIDYASAGAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-405-0205
Mailing Address - Street 1:174 GRAND ST
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-4803
Mailing Address - Country:US
Mailing Address - Phone:914-328-8077
Mailing Address - Fax:914-328-6083
Practice Address - Street 1:741 EAST 233RD STREET
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466
Practice Address - Country:US
Practice Address - Phone:718-405-0203
Practice Address - Fax:718-405-1628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1442222084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWEN461Medicare ID - Type Unspecified