Healthcare Provider Details

I. General information

NPI: 1902290661
Provider Name (Legal Business Name): HUDSON LIFE MEDICAL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2015
Last Update Date: 11/16/2023
Certification Date: 02/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 7TH AVENUE S UNIT B
NEW YORK NY
10014-2727
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: 646-850-9326
Mailing address:
  • Phone: 646-596-7386
  • Fax: 646-360-2739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

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