Provider Demographics
NPI:1104085851
Name:HUSSON, PAUL JOSEPH JR (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JOSEPH
Last Name:HUSSON
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:99 E STATE ST
Mailing Address - Street 2:PO BOX 1250
Mailing Address - City:GLOVERSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12078-1203
Mailing Address - Country:US
Mailing Address - Phone:518-775-4133
Mailing Address - Fax:518-773-5620
Practice Address - Street 1:99 E STATE ST
Practice Address - Street 2:MAB-GPCC
Practice Address - City:GLOVERSVILLE
Practice Address - State:NY
Practice Address - Zip Code:12078-1203
Practice Address - Country:US
Practice Address - Phone:518-775-4133
Practice Address - Fax:518-773-5620
Is Sole Proprietor?:No
Enumeration Date:2008-06-07
Last Update Date:2015-01-21
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Provider Licenses
StateLicense IDTaxonomies
NY251814208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1104085851OtherMVP HEALTHCARE
NY03382616Medicaid
NY200230284OtherCDPHP
NY200230284OtherCDPHP