Basic Information
| Provider Information | |||||||||
| NPI: | 1790921070 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COLUMBIA MEMORIAL HOSPITAL | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | COLUMBIA MEMORIAL BONE & JOINT CENTER (HUDSON) | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2000 | ||||||||
| Address2: | |||||||||
| City: | HUDSON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125342000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5188288363 | ||||||||
| FaxNumber: | 5186973388 | ||||||||
| Practice Location | |||||||||
| Address1: | 23 FISH AND GAME RD | ||||||||
| Address2: | |||||||||
| City: | HUDSON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125343815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5188287644 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/17/2008 | ||||||||
| LastUpdateDate: | 09/04/2012 | ||||||||
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| AuthorizedOfficialLastName: | ANDERSON | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
| AuthorizedOfficialMiddleName: | MARK | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT PRACTICE MANAGEMENT | ||||||||
| AuthorizedOfficialTelephone: | 5188288185 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | COLUMBIA MEMORIAL HOSPITAL | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.