Provider Demographics
NPI:1548771074
Name:CHRISTOPHER A DUDLEY
Entity type:Organization
Organization Name:CHRISTOPHER A DUDLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:C
Authorized Official - Last Name:ARMSTRONG
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:518-499-2541
Mailing Address - Street 1:PO BOX 46
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:NY
Mailing Address - Zip Code:12887-0046
Mailing Address - Country:US
Mailing Address - Phone:518-499-2541
Mailing Address - Fax:518-499-2145
Practice Address - Street 1:10139 ROUTE 4
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:NY
Practice Address - Zip Code:12887
Practice Address - Country:US
Practice Address - Phone:518-499-2541
Practice Address - Fax:518-499-2145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-24
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0309641Medicaid