Provider Demographics
NPI:1144215161
Name:MID HUDSON PLASTIC SURGERY PC
Entity type:Organization
Organization Name:MID HUDSON PLASTIC SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GROUP OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGERTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-338-0799
Mailing Address - Street 1:117 MARYS AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-5849
Mailing Address - Country:US
Mailing Address - Phone:845-338-0789
Mailing Address - Fax:845-334-9150
Practice Address - Street 1:117 MARYS AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-5849
Practice Address - Country:US
Practice Address - Phone:845-338-0789
Practice Address - Fax:845-334-9150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-15
Last Update Date:2016-09-21
Deactivation Date:2008-06-10
Deactivation Code:
Reactivation Date:2009-03-05
Provider Licenses
StateLicense IDTaxonomies
NY2017201208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty