Healthcare Provider Details

I. General information

NPI: 1144788183
Provider Name (Legal Business Name): HUDSON ORTHO GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2019
Last Update Date: 03/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 MARKET ST STE 2A
SADDLE BROOK NJ
07663-5996
US

IV. Provider business mailing address

1320 ADAMS ST STE E
HOBOKEN NJ
07030-2370
US

V. Phone/Fax

Practice location:
  • Phone: 201-308-6622
  • Fax: 201-308-6623
Mailing address:
  • Phone: 201-308-6622
  • Fax: 201-308-6623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: THOMAS AZZOLINI
Title or Position: AUTHORIZED OFFICIAL
Credential: DPM
Phone: 201-308-6622