Provider Demographics
NPI:1811551252
Name:HODGE, ARTHUR SAMUEL JR
Entity type:Individual
Prefix:
First Name:ARTHUR
Middle Name:SAMUEL
Last Name:HODGE
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 1:16318 JAMAICA AVE STE 502
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-4919
Mailing Address - Country:US
Mailing Address - Phone:718-658-0010
Mailing Address - Fax:718-658-2909
Practice Address - Street 1:16318 JAMAICA AVE STE 502
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-4919
Practice Address - Country:US
Practice Address - Phone:718-658-0010
Practice Address - Fax:718-658-2909
Is Sole Proprietor?:No
Enumeration Date:2019-04-30
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY194629207R00000X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine