Healthcare Provider Details

I. General information

NPI: 1912677675
Provider Name (Legal Business Name): HUDSON VASCULAR PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2021
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 BAY RIDGE AVE
BROOKLYN NY
11220-5315
US

IV. Provider business mailing address

18 MERCER ST FL 6
NEW YORK NY
10013-2527
US

V. Phone/Fax

Practice location:
  • Phone: 917-475-6822
  • Fax:
Mailing address:
  • Phone: 212-389-5988
  • Fax: 516-569-3677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. NATALIE WEIKERT
Title or Position: OFFICE MANAGER
Credential:
Phone: 937-760-8789