MEDICARE: HUDSON PHYSIO & SPORTS PC

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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1821701749
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUDSON PHYSIO & SPORTS PC

Provider Business Mailing Address
First Line	:	4800 BROADWAY STE 212
Second Line	:
City	:	UNION CITY
State	:	NJ
Zip	:	07087-6544
Country	:	US
Telephone Number	:	201-766-1728
Fax Number	:

Provider Business Practice Location Address
First Line	:	74 HUDSON ST
Second Line	:
City	:	HOBOKEN
State	:	NJ
Zip	:	07030-6191
Country	:	US
Telephone Number	:	877-576-4681
Fax Number	:

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	YISEHANNIE PEREZ
Credential	:
Telephone Number	:	201-766-1728

Provider Enumeration Date	:	01/05/2023
Last Update Date	:	01/05/2023

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