Basic Information
| Provider Information | |||||||||
| NPI: | 1811949589 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MID HUDSON PHYSICIANS, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 396 BROADWAY | ||||||||
| Address2: | |||||||||
| City: | KINGSTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 124014626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453342700 | ||||||||
| FaxNumber: | 8453342898 | ||||||||
| Practice Location | |||||||||
| Address1: | 396 BROADWAY | ||||||||
| Address2: | |||||||||
| City: | KINGSTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 124014626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453342700 | ||||||||
| FaxNumber: | 8453342898 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2006 | ||||||||
| LastUpdateDate: | 11/04/2010 | ||||||||
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| AuthorizedOfficialLastName: | EHRLICH | ||||||||
| AuthorizedOfficialFirstName: | FRANK | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8453342700 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 02768734 | 05 | NY | MEDICAID |