=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518178631
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HUDSON VALLEY PODIATRY ASSOCIATES, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/24/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2050 SAW MILL RIVER RD
-----------------------------------------------------
City | YORKTOWN HEIGHTS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10598-4108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-245-7888
-----------------------------------------------------
Fax | 914-245-7909
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2050 SAW MILL RIVER RD
-----------------------------------------------------
City | YORKTOWN HEIGHTS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10598-4108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-245-7888
-----------------------------------------------------
Fax | 914-245-7909
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | WAYNE BLOOM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 914-245-7888
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0131X
-----------------------------------------------------
Taxonomy Name | Foot Surgery Podiatrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------