=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053128363
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HUDSON FAMILY MEDICAL PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/11/2024
-----------------------------------------------------
Last Update Date | 12/11/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 226 N MAIN ST
-----------------------------------------------------
City | NEW CITY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10956-5302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-204-8480
-----------------------------------------------------
Fax | 845-502-9520
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 226 N MAIN ST
-----------------------------------------------------
City | NEW CITY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10956-5302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-204-8480
-----------------------------------------------------
Fax | 845-502-9520
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AUTHORIZED OFFICIAL
-----------------------------------------------------
Name | ADEEL SHAHID YOUSPHI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 845-204-8480
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------