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General NPI Number Information
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NPI Number | 1407479165
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Entity Type | Organization
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Legal Business Name | HUDSON SURGICAL ASSOCIATES
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Dates
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Enumeration Date | 05/28/2020
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Last Update Date | 05/28/2020
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Provider Practice Location Address
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Address Line | 114 ESSEX ST STE 102
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City | ROCHELLE PARK
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State | NJ
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Zip | 07662-4342
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Country | US
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Telephone | 212-203-2146
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Fax | 212-537-0345
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Provider Business Mailing Address
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Address Line | 114 ESSEX ST STE 102
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City | ROCHELLE PARK
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State | NJ
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Zip | 07662-4342
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Country | US
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Telephone | 212-203-2146
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Fax | 212-537-0345
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | MARY M. LEGG
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Credential |
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Telephone | 347-584-8903
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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