1063572246 NPI number — HUDSON HEART GROUP, PC

Table of content: (NPI 1063572246)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063572246 NPI number — HUDSON HEART GROUP, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HUDSON HEART GROUP, PC
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:
1063572246
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2566
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GUTTENBERG
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07093-0641
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-854-0055
Provider Business Mailing Address Fax Number:
201-854-2633

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
425 70TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GUTTENBERG
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07093-2417
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-854-0055
Provider Business Practice Location Address Fax Number:
201-854-2633
Provider Enumeration Date:
12/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SANTANA
Authorized Official First Name:
JOSE
Authorized Official Middle Name:
Authorized Official Title or Position:
M.D.
Authorized Official Telephone Number:
201-854-0055

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  25MA05225300 , 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: 8750079 . This is a "AETNA PPO GROUP #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2749194 . This is a "AETNA HMO GROUP #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: W7H321 . This is a "BC/BS NY GROUP #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2081205005 . This is a "AMERIHEALTH (SECAUCUS) #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2081205001 . This is a "AMERIHEALTH (GUTTENBERG)#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2081205003 . This is a "AMERIHEALTH (NEWARK) #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: CJ9162 . This is a "RAILROAD MDCR GROUP #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 5581702 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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