=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639286735
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HUDSON IMAGING PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/24/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 75 MONTGOMERY STREET SUITE 401
-----------------------------------------------------
City | JERSEY CITY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-369-1900
-----------------------------------------------------
Fax | 201-369-9300
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 75 MONTGOMERY STREET SUITE 401
-----------------------------------------------------
City | JERSEY CITY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-369-1900
-----------------------------------------------------
Fax | 201-369-9300
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | KAMAL C GREISS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 201-369-1900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | 23417
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------