Healthcare Provider Details

I. General information

NPI: 1952005373
Provider Name (Legal Business Name): HUDSON PRO ORTHOPAEDICS AND SPORTS MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 03/29/2023
Certification Date: 03/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

571 LAFAYETTE AVE
HAWTHORNE NJ
07506-2424
US

IV. Provider business mailing address

571 LAFAYETTE AVE
HAWTHORNE NJ
07506-2424
US

V. Phone/Fax

Practice location:
  • Phone: 201-308-6622
  • Fax:
Mailing address:
  • Phone: 201-308-6622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: IMRAM ASHRAF
Title or Position: OWNER
Credential: MD
Phone: 201-308-6623