MEDICARE: HUDSON NEUROLOGY AND NEUROPHYSIOLOGY PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	205230	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2C6986	OTHER	NY	HEALTHNET
2	P1045613	OTHER	NY	OXFORD

General Provider Information

NPI Number	:	1033124821
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUDSON NEUROLOGY AND NEUROPHYSIOLOGY PC

Provider Business Mailing Address
First Line	:	245 N BROADWAY STE 102
Second Line	:
City	:	SLEEPY HOLLOW
State	:	NY
Zip	:	10591-2657
Country	:	US
Telephone Number	:	914-631-6888
Fax Number	:	914-631-2700

Provider Business Practice Location Address
First Line	:	245 N BROADWAY STE 102
Second Line	:
City	:	SLEEPY HOLLOW
State	:	NY
Zip	:	10591-2657
Country	:	US
Telephone Number	:	914-631-6888
Fax Number	:	914-631-2700

Authorized Official
Title or Position	:	MEDICAL BILLING MANAGER
Name	:	MRS. DOROTHEA KELLIGREW
Credential	:
Telephone Number	:	914-631-3640

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	04/01/2009

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