Healthcare Provider Details

I. General information

NPI: 1679658462
Provider Name (Legal Business Name): HUDSON THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 01/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 PAVONIA AVE 7TH FLOOR
JERSEY CITY NJ
07306-2929
US

IV. Provider business mailing address

600 PAVONIA AVE 7TH FLOOR
JERSEY CITY NJ
07306-2929
US

V. Phone/Fax

Practice location:
  • Phone: 201-418-0088
  • Fax: 201-418-9420
Mailing address:
  • Phone: 201-418-0088
  • Fax: 201-418-9420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number063647
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number22936
License Number StateNJ

VIII. Authorized Official

Name: DR. SPENCER JASON MALKIN
Title or Position: CEO
Credential:
Phone: 917-815-2299