Healthcare Provider Details

I. General information

NPI: 1306593033
Provider Name (Legal Business Name): HUDON VALLEY MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2022
Last Update Date: 03/02/2022
Certification Date: 03/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 VERONICA AVE
SOMERSET NJ
08873-3579
US

IV. Provider business mailing address

188 LUDLOW ST APT 6B
NEW YORK NY
10002-1682
US

V. Phone/Fax

Practice location:
  • Phone: 732-339-3068
  • Fax:
Mailing address:
  • Phone: 305-720-6930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JUDSON KROSNEY
Title or Position: PRESIDENT
Credential: MD
Phone: 305-720-6930