Provider Demographics
NPI:1205423183
Name:HUDAK, WILLIAM JR
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:
Last Name:HUDAK
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2805 BEARS DEN CT
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44511-1213
Mailing Address - Country:US
Mailing Address - Phone:133-079-2876
Mailing Address - Fax:
Practice Address - Street 1:2805 BEARS DEN CT
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44511-1213
Practice Address - Country:US
Practice Address - Phone:330-792-8761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0333791374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide