Healthcare Provider Details

I. General information

NPI: 1427511187
Provider Name (Legal Business Name): HUDSON PREMIER HEALTHCARE PARTNERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2019
Last Update Date: 04/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 WESTMINSTER AVE
ELIZABETH NJ
07208-2202
US

IV. Provider business mailing address

511 WESTMINSTER AVE
ELIZABETH NJ
07208-2202
US

V. Phone/Fax

Practice location:
  • Phone: 908-764-7704
  • Fax:
Mailing address:
  • Phone: 908-764-7704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL LATZA
Title or Position: MANAGER
Credential: DC
Phone: 732-882-1895