| Organization Name: | HUDSON MOHAWK PEDIATRICS |
| NPI Number: | 1225393986 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GAYLE BUCKLEY (OWNER) |
| Mailing Address: | 318 Ruhle Rd S Ballston Lake |
| State: | NY US |
| Postal Code: | 120191030 |
| Phone Number: | 5188994133 |
| Fax Number: | |
| NPI Enumeration Date: | 07/09/2012 |
| NPI Last Update Date: | 07/09/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 282NC2000X |
| License Number: | 107075 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Hospitals |
| Taxonomy Classification: | General Acute Care Hospital |
| Taxonomy Specialization: | Children |
| Taxonomy Definition: | |