Healthcare Provider Details

I. General information

NPI: 1083096960
Provider Name (Legal Business Name): HUDSON MEDICAL WELLNESS ,PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2015
Last Update Date: 02/22/2022
Certification Date: 02/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

281 BROADWAY 2ND FLOOR
NEW YORK NY
10007-1831
US

IV. Provider business mailing address

281 BROADWAY 2ND FLOOR
NEW YORK NY
10007-1831
US

V. Phone/Fax

Practice location:
  • Phone: 646-596-7386
  • Fax: 646-360-2739
Mailing address:
  • Phone: 646-596-7386
  • Fax: 646-360-2739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: JONATHANN C KUO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 646-596-7386