Provider Demographics
NPI:1942824867
Name:HUDSON PLASTIC SURGERY LLC
Entity type:Organization
Organization Name:HUDSON PLASTIC SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:GANDOLFI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-287-7211
Mailing Address - Street 1:25 5TH AVE SUITE 1F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4308
Mailing Address - Country:US
Mailing Address - Phone:212-287-7211
Mailing Address - Fax:212-287-7210
Practice Address - Street 1:25 5TH AVE
Practice Address - Street 2:SUITE 1F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4308
Practice Address - Country:US
Practice Address - Phone:212-287-7211
Practice Address - Fax:212-287-7210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-05
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty