Healthcare Provider Details

I. General information

NPI: 1104842756
Provider Name (Legal Business Name): HUDSON VALLEY MEDICAL GROUP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 S DIVISION ST
PEEKSKILL NY
10566-3611
US

IV. Provider business mailing address

211 S DIVISION ST
PEEKSKILL NY
10566-3611
US

V. Phone/Fax

Practice location:
  • Phone: 914-788-9719
  • Fax: 914-788-9719
Mailing address:
  • Phone: 914-788-9719
  • Fax: 914-788-9719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. WIJAYAN RATNATHICAM
Title or Position: PRESIDENT
Credential: M.D.
Phone: 914-788-9719