HUDSON MOHAWK PEDIATRICS; NPI #1225393986

Contact Information

HUDSON MOHAWK PEDIATRICS

318 RUHLE RD S
BALLSTON LAKE, NY 12019-1030

Phone: 518-899-4133
Fax:
Website:

	Specialty	Taxonomy Code	Specialty Code	Provider Type
	Children	282NC2000X	A0[7]	Hospital-Childrenâ€™s (PPS excluded)

Indicates primary specialty

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NPI Profile & details for HUDSON MOHAWK PEDIATRICS

NPI # 1225393986

LBN Legal business name HUDSON MOHAWK PEDIATRICS

Authorized official GAYLE BUCKLEY - (OWNER)

Entity Organization

Organization subpart ¹ No

Enumeration date 07/09/2012

Last updated 07/09/2012 - About 14 years ago

Identifiers

NY	License #	107075
NY	Medicaid	00628079

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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