Healthcare Provider Details

I. General information

NPI: 1902213069
Provider Name (Legal Business Name): HUDSON PODIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2014
Last Update Date: 11/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 CORPORATE DR SUITE B
HUDSON OH
44236-4453
US

IV. Provider business mailing address

1315 CORPORATE DR SUITE B
HUDSON OH
44236-4453
US

V. Phone/Fax

Practice location:
  • Phone: 330-655-5000
  • Fax: 330-342-9582
Mailing address:
  • Phone: 330-655-5000
  • Fax: 330-342-9582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: RONALD ALAN STEIN
Title or Position: OWNER
Credential: DPM
Phone: 330-655-5000