1497066476 NPI number — HUDSON INTERNAL MEDICINE, PA

Table of content: (NPI 1497066476)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497066476 NPI number — HUDSON INTERNAL MEDICINE, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HUDSON INTERNAL MEDICINE, 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:
1497066476
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/24/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
550 NEWARK AVE
Provider Second Line Business Mailing Address:
SUITE 302
Provider Business Mailing Address City Name:
JERSEY CITY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07306-1326
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-222-8288
Provider Business Mailing Address Fax Number:
201-222-8265

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
550 NEWARK AVE
Provider Second Line Business Practice Location Address:
SUITE 302
Provider Business Practice Location Address City Name:
JERSEY CITY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07306-1326
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-222-8288
Provider Business Practice Location Address Fax Number:
201-222-8265
Provider Enumeration Date:
06/24/2010

Additional Information

Authorized Official

Authorized Official Last Name:
CHOI
Authorized Official First Name:
JEA KEUN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
201-222-8288

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  25MA05669400 , 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: 1453618-001 . This is a "CIGNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5173809 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4226989 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 110147933 . This is a "PALMETTO GBA - RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2501688 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4121011 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: J1904 . This is a "HORIZON BCBS - NJ" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10G451 . This is a "EMPIRE BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 140137 . This is a "US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 691768 . This is a "MEDICARE - LEGACY #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 392388 . This is a "WELLCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1094921 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: HP063 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".




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