Healthcare Provider Details

I. General information

NPI: 1275524035
Provider Name (Legal Business Name): HOWARD P HUDSON DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 03/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 ROUTE 70 SUITE 21 S
LAKEWOOD NJ
08701-5900
US

IV. Provider business mailing address

1255 ROUTE 70 SUITE 21 S
LAKEWOOD NJ
08701-5900
US

V. Phone/Fax

Practice location:
  • Phone: 732-367-2220
  • Fax: 732-367-2293
Mailing address:
  • Phone: 732-367-2220
  • Fax: 732-367-2293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberMD000958
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: