Provider Demographics
NPI:1568650372
Name:HUGO LEDESMA, M.D., P.C.
Entity type:Organization
Organization Name:HUGO LEDESMA, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HUGO
Authorized Official - Middle Name:OSWALDO
Authorized Official - Last Name:LEDESMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-507-2300
Mailing Address - Street 1:3726 76TH ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-6534
Mailing Address - Country:US
Mailing Address - Phone:718-507-2300
Mailing Address - Fax:718-507-1351
Practice Address - Street 1:3726 76TH ST
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-6534
Practice Address - Country:US
Practice Address - Phone:718-507-2300
Practice Address - Fax:718-507-1351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY197212207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG42332Medicare UPIN