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General NPI Number Information
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NPI Number | 1518541010
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Entity Type | Individual
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Provider Name | BRIAN GREGORY HODGE
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Gender | Male
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Dates
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Enumeration Date | 05/11/2021
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Last Update Date | 08/01/2025
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Provider Practice Location Address
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Address Line | 375 SEGUINE AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10309-3932
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Country | US
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Telephone | 518-226-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 181 PALMETTO ST APT 1R
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City | BROOKLYN
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State | NY
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Zip | 11221-4729
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Country | US
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Telephone | 516-459-5529
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 325077
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License Number State | NY
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