Provider Demographics
NPI:1962189324
Name:HUDSON VALLEY HAIR LOSS
Entity type:Organization
Organization Name:HUDSON VALLEY HAIR LOSS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:PROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-219-5400
Mailing Address - Street 1:522 LATTINTOWN RD
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:NY
Mailing Address - Zip Code:12542-5158
Mailing Address - Country:US
Mailing Address - Phone:845-863-9977
Mailing Address - Fax:
Practice Address - Street 1:42 MAIN STREET
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:NY
Practice Address - Zip Code:12547-6164
Practice Address - Country:US
Practice Address - Phone:845-219-5400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-28
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier