Healthcare Provider Details

I. General information

NPI: 1104736610
Provider Name (Legal Business Name): HUDSON STATE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

25 WALDRON AVE
NYACK NY
10960-2935
US

IV. Provider business mailing address

25 WALDRON AVE
NYACK NY
10960-2935
US

V. Phone/Fax

Practice location:
  • Phone: 877-468-3690
  • Fax: 919-296-1331
Mailing address:
  • Phone: 877-468-3690
  • Fax: 919-296-1331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: FREDERICK LEE JONES
Title or Position: OPERATIONS MANAGER / OWNER
Credential:
Phone: 845-327-3481