MEDICARE: HUDSON SPINE INSTITUTE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NR0400X	Rehabilitation Chiropractor

General Provider Information

NPI Number	:	1790387371
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUDSON SPINE INSTITUTE

Provider Business Mailing Address
First Line	:	8901 KENNEDY BLVD STE 3W
Second Line	:
City	:	NORTH BERGEN
State	:	NJ
Zip	:	07047-5392
Country	:	US
Telephone Number	:	201-907-4727
Fax Number	:	201-907-4737

Provider Business Practice Location Address
First Line	:	8901 KENNEDY BLVD STE 3W
Second Line	:
City	:	NORTH BERGEN
State	:	NJ
Zip	:	07047-5392
Country	:	US
Telephone Number	:	201-907-4727
Fax Number	:	201-907-4737

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	CRYSTAL LESLIE
Credential	:
Telephone Number	:	201-838-1900

Provider Enumeration Date	:	11/10/2020
Last Update Date	:	11/10/2020

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