Healthcare Provider Details

I. General information

NPI: 1497301998
Provider Name (Legal Business Name): HUDSON MD GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2019
Last Update Date: 08/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

464 HUDSON TER STE 201
ENGLEWOOD CLIFFS NJ
07632-2917
US

IV. Provider business mailing address

464 HUDSON TER STE 201
ENGLEWOOD CLIFFS NJ
07632-2917
US

V. Phone/Fax

Practice location:
  • Phone: 201-503-0828
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: RAJAVELU DHARMARAJ
Title or Position: ACCOUNTS MANAGER
Credential:
Phone: 203-648-5087