MEDICARE: HUDSON PODIATRY ASSOCIATES, 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	213ES0131X	Foot Surgery Podiatrist	N-004712	NY
2	213ES0131X	Foot Surgery Podiatrist	N-004707	NY

General Provider Information

NPI Number	:	1659410934
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUDSON PODIATRY ASSOCIATES, PC

Provider Business Mailing Address
First Line	:	2050 SAW MILL RIVER RD
Second Line	:
City	:	YORKTOWN HEIGHTS
State	:	NY
Zip	:	10598-4108
Country	:	US
Telephone Number	:	914-245-7888
Fax Number	:	914-245-7909

Provider Business Practice Location Address
First Line	:	2050 SAW MILL RIVER RD
Second Line	:
City	:	YORKTOWN HEIGHTS
State	:	NY
Zip	:	10598-4108
Country	:	US
Telephone Number	:	914-245-7888
Fax Number	:	914-245-7909

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. WAYNE BLOOM
Credential	:	DPM
Telephone Number	:	914-245-7888

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	08/11/2015

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