Healthcare Provider Details

I. General information

NPI: 1750171823
Provider Name (Legal Business Name): WENDY CARLENE HUDSON APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2025
Last Update Date: 05/10/2025
Certification Date: 05/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

459 JACK MARTIN BLVD STE 6
BRICK NJ
08724-7724
US

IV. Provider business mailing address

286 WISTERIA DR
BRICK NJ
08723-5918
US

V. Phone/Fax

Practice location:
  • Phone: 732-785-1000
  • Fax: 732-785-1222
Mailing address:
  • Phone: 732-642-0285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberWAITING
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: