Healthcare Provider Details

I. General information

NPI: 1154591980
Provider Name (Legal Business Name): HOWARD HUDSON DPM PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2008
Last Update Date: 12/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

1255 RT 70 SUITE 21S
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 Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberMD000958
License Number StateNJ

VIII. Authorized Official

Name: DR. HOWARD P HUDSON
Title or Position: OWNER
Credential: DPM
Phone: 732-367-2220