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NPI Code Detail

MEDICARE: DEREK HUDSON SUITE M.D.

MEDICARE: DEREK HUDSON SUITE M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry Physician198909-1NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1467433862
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEREK HUDSON SUITE M.D.
Provider Business Mailing Address
First Line : 1136 NEILL AVENUE
Second Line :
City : BRONX
State : NY
Zip : 10461-2801
Country : US
Telephone Number : 718-518-7600
Fax Number : 718-518-7647
Provider Business Practice Location Address
First Line : 1136 NEILL AVE
Second Line :
City : BRONX
State : NY
Zip : 10461-1328
Country : US
Telephone Number : 718-518-7600
Fax Number : 718-518-7647
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/11/2005
Last Update Date : 05/27/2015

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