Provider Demographics
NPI:1316670946
Name:HUDSON PAIN MEDICINE, P.C
Entity type:Organization
Organization Name:HUDSON PAIN MEDICINE, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:CHINWEIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:IZEOGU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-381-1164
Mailing Address - Street 1:400 ROUTE 211 E STE 12
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-2123
Mailing Address - Country:US
Mailing Address - Phone:845-381-1164
Mailing Address - Fax:
Practice Address - Street 1:400 ROUTE 211 E STE 12
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-2123
Practice Address - Country:US
Practice Address - Phone:845-381-1164
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-01
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY235169OtherSTATE LICENSE