Healthcare Provider Details

I. General information

NPI: 1659832954
Provider Name (Legal Business Name): ADAM HURD LDO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2019
Last Update Date: 03/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

983 CENTRAL PARK AVE
SCARSDALE NY
10583-3211
US

IV. Provider business mailing address

983 CENTRAL PARK AVE
SCARSDALE NY
10583-3211
US

V. Phone/Fax

Practice location:
  • Phone: 914-874-2041
  • Fax:
Mailing address:
  • Phone: 914-874-2041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number010153
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: