Healthcare Provider Details

I. General information

NPI: 1184140428
Provider Name (Legal Business Name): HUDSON CENTER FOR DIGESTIVE HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2017
Last Update Date: 08/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

534 AVENUE E STE 1-A
BAYONNE NJ
07002-3987
US

IV. Provider business mailing address

32 RICHARD RD
EDISON NJ
08820-2515
US

V. Phone/Fax

Practice location:
  • Phone: 201-858-8444
  • Fax: 201-858-4260
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMA06946500
License Number StateNJ

VIII. Authorized Official

Name: KOVIL RAMASAMY
Title or Position: OWNER
Credential: MD
Phone: 201-858-8444