Hudson Shores Medical Group PLLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

HUDSON SHORES MEDICAL GROUP PLLC

Practice address

1500 2ND Ave
Watervliet, NY 12189-2800

Phone

(518) 272-0028

NPI assigned

Sep 21, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Ram Agrawal B, MD

Title

President

Phone

(518) 272-0028

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1300406400000",
    "number": "1205934148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 2ND AVE",
            "city": "WATERVLIET",
            "state": "NY",
            "postal_code": "121892800",
            "telephone_number": "518-272-0028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 2ND AVE",
            "city": "WATERVLIET",
            "state": "NY",
            "postal_code": "121892800",
            "telephone_number": "518-272-0028"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HUDSON SHORES MEDICAL GROUP PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-21",
        "last_updated": "2011-03-18",
        "status": "A",
        "authorized_official_last_name": "B",
        "authorized_official_first_name": "RAM",
        "authorized_official_middle_name": "AGRAWAL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "518-272-0028",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02177677",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sara E Heidelmark
• Moira Hilt, PT
• William James Hogan, D.D.S.
• Debra Marie Hotaling, R.PH.
• Kara Howansky, OTD, OTR/L
• Kathleen Ann Innes, LMSW, MA
• Integrity Case Management Services LLC
• Cassandra T Jaquish, FNP-BC
• Tierra Jobson, M.S. CCC-SLP
• Deborah Elizabeth Johnson, LPN

• Internal Medicine Physician in Watervliet, NY
• Providers in Watervliet, NY by specialty
• Internal Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.