1639286735 NPI number — HUDSON IMAGING PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639286735 NPI number — HUDSON IMAGING PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HUDSON IMAGING PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639286735
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
75 MONTGOMERY STREET
Provider Second Line Business Mailing Address:
SUITE 401
Provider Business Mailing Address City Name:
JERSEY CITY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-369-1900
Provider Business Mailing Address Fax Number:
201-369-9300

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
75 MONTGOMERY STREET
Provider Second Line Business Practice Location Address:
SUITE 401
Provider Business Practice Location Address City Name:
JERSEY CITY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-369-1900
Provider Business Practice Location Address Fax Number:
201-369-9300
Provider Enumeration Date:
08/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GREISS
Authorized Official First Name:
KAMAL
Authorized Official Middle Name:
C
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
201-369-1900

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  23417 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 101408 . This is a "AMERIGROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2964536 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7249376 . This is a "AETNA ALL OTHERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8820902 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: W1L831 . This is a "WELLCHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1412491 . This is a "AMERIHEALTH PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2099468000 . This is a "AMERIHEALTH HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8820902 . This is a "UNISYS" identifier . This identifiers is of the category "OTHER".
  • Identifier: A2839370 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 056977 . This is a "RAILROAD MEDICARE PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1171229 . This is a "HORIZON NJ HEALTH MERCY" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: HUL00020901 . This is a "AMERICHOICE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 7249376 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".




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