Healthcare Provider Details

I. General information

NPI: 1932180544
Provider Name (Legal Business Name): MARC HUDES DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 05/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 BROADWAY SUITE 2
MONTICELLO NY
12701-1742
US

IV. Provider business mailing address

427 BROADWAY SUITE 2
MONTICELLO NY
12701-1742
US

V. Phone/Fax

Practice location:
  • Phone: 845-794-7741
  • Fax: 845-794-0228
Mailing address:
  • Phone: 845-794-7741
  • Fax: 845-794-0228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number002431
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: