MEDICARE: HUDSON TERRACE MEDICAL, P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center	25MA05670900	NJ

General Provider Information

NPI Number	:	1518021039
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUDSON TERRACE MEDICAL, P.A.

Provider Business Mailing Address
First Line	:	464 HUDSON TERRACE
Second Line	:	SUITE #102
City	:	ENGLEWOOD CLIFFS
State	:	NJ
Zip	:	07632-2917
Country	:	US
Telephone Number	:	201-503-0066
Fax Number	:	201-503-0190

Provider Business Practice Location Address
First Line	:	464 HUDSON TERRACE
Second Line	:	SUITE #102
City	:	ENGLEWOOD CLIFFS
State	:	NJ
Zip	:	07632-2917
Country	:	US
Telephone Number	:	201-503-0066
Fax Number	:	201-503-0190

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. TAEWON MOON
Credential	:	M.D.
Telephone Number	:	201-503-0066

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	07/23/2014

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