Provider Demographics
NPI:1295720647
Name:HODES, DAVID L (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:HODES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994-1965
Mailing Address - Country:US
Mailing Address - Phone:845-727-7733
Mailing Address - Fax:
Practice Address - Street 1:2 MEDICAL PARK DRIVE
Practice Address - Street 2:SUITE 3
Practice Address - City:W. NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994
Practice Address - Country:US
Practice Address - Phone:845-727-7733
Practice Address - Fax:845-727-7743
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1270021207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0018574OtherGHI HMO
270937303OtherGHI
040426011550OtherFIDELIS MEDICAID HMO
0D0702OtherHEALTH NET
132995699OtherHUDSON HEALTH PLAN
172690OtherONE HEALTH PLAN
341111OtherBC BS EMPIRE
NY93968209OtherUHC
132995699OtherLOCAL 1199
132995699OtherMUTLIPLAN
NY270937303OtherMULTIPLAN
NY070CZ1OtherEMPIRE BC/BS
132995699OtherBEECH STREET NETWORK
101119OtherAETNA USHC
132995699OtherCIGNA PPO
341111OtherMEDICARE
NY00790276Medicaid
127002OtherLICENSE NUMBER
132995699OtherHEALTH NOW
132995699OtherINDECS
132995699OtherMAGNACARE
5477042OtherAETNA
NY8204859013OtherCIGNA
C08815Medicare UPIN
341111Medicare ID - Type Unspecified