Provider Demographics
NPI:1861580755
Name:HODOSH, RICHARD MICHAEL (MD FACS)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:MICHAEL
Last Name:HODOSH
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Gender:M
Credentials:MD FACS
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Mailing Address - Street 1:99 BEAUVOIR AVENUE
Mailing Address - Street 2:ATLANTIC BRAIN & SPINE LLC
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901
Mailing Address - Country:US
Mailing Address - Phone:908-522-4979
Mailing Address - Fax:908-522-5377
Practice Address - Street 1:99 BEAUVOIR AVENUE
Practice Address - Street 2:ATLANTIC BRAIN & SPINE INSTITUTE
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901
Practice Address - Country:US
Practice Address - Phone:908-522-4979
Practice Address - Fax:908-522-5377
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2011-05-13
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA037407207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0182109Medicaid
NJ182980Medicare PIN
NJ0182109Medicaid