Healthcare Provider Details

I. General information

NPI: 1558810309
Provider Name (Legal Business Name): JAMES HODGE AG-ANCP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2016
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1436 WILLIAMSBRIDGE RD
BRONX NY
10461-2507
US

IV. Provider business mailing address

3026 TIEMANN AVE
BRONX NY
10469-3216
US

V. Phone/Fax

Practice location:
  • Phone: 646-759-5459
  • Fax:
Mailing address:
  • Phone: 410-608-5376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberLP-0000348
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberR192286
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberF432016-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: