Healthcare Provider Details

I. General information

NPI: 1053470047
Provider Name (Legal Business Name): HUDSON CO BOARD OF CHOSEN FREEHOLD ADMIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 04/08/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 COUNTY AVE BLDG 10
SECAUCUS NJ
07094-2605
US

IV. Provider business mailing address

595 COUNTY AVE BLDG 10
SECAUCUS NJ
07094-2605
US

V. Phone/Fax

Practice location:
  • Phone: 201-319-5252
  • Fax: 201-369-5265
Mailing address:
  • Phone: 201-369-5252
  • Fax: 201-369-5261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number60908
License Number StateNJ

VIII. Authorized Official

Name: MR. JOSE R OLAYA
Title or Position: COMPTROLLER
Credential:
Phone: 201-369-5252