Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 019328 | NY |
Y | 103T00000X | Psychologist | 019328 | NY |
NPI | 1013201227 |
---|---|
Provider Name | Dr. Philip Nordan Hudson JR. |
First Address | New York, NY 10011-8971 |
Second Address | New York, NY 10011-8971 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2011 |
Last Update Date | 17/10/2011 |