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General NPI Number Information
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NPI Number | 1518021039
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Entity Type | Organization
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Legal Business Name | HUDSON TERRACE MEDICAL, P.A.
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 07/23/2014
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Provider Practice Location Address
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Address Line | 464 HUDSON TERRACE SUITE #102
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City | ENGLEWOOD CLIFFS
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State | NJ
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Zip | 07632-2917
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Country | US
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Telephone | 201-503-0066
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Fax | 201-503-0190
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Provider Business Mailing Address
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Address Line | 464 HUDSON TERRACE SUITE #102
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City | ENGLEWOOD CLIFFS
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State | NJ
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Zip | 07632-2917
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Country | US
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Telephone | 201-503-0066
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Fax | 201-503-0190
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. TAEWON MOON
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Credential | M.D.
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Telephone | 201-503-0066
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 25MA05670900
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License Number State | NJ
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