Healthcare Provider Details

I. General information

NPI: 1548809221
Provider Name (Legal Business Name): HUDSON PREMIER MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2019
Last Update Date: 02/02/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 MEADOWLANDS PKWY
SECAUCUS NJ
07094-2977
US

IV. Provider business mailing address

PO BOX 825403
PHILADELPHIA PA
19182-5403
US

V. Phone/Fax

Practice location:
  • Phone: 201-325-6744
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: NIZAR KIFAIEH
Title or Position: PRESIDENT
Credential: MD
Phone: 201-392-3100