MEDICARE: HUDSON CARE PHYSICAL THERAPY PLLC

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	261QP2000X	Physical Therapy Clinic/Center	018005	NY

General Provider Information

NPI Number	:	1881920874
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUDSON CARE PHYSICAL THERAPY PLLC

Provider Business Mailing Address
First Line	:	80 RIVER ST
Second Line	:	SUITE 5A
City	:	HOBOKEN
State	:	NJ
Zip	:	07030-5626
Country	:	US
Telephone Number	:	201-683-9453
Fax Number	:	201-683-5612

Provider Business Practice Location Address
First Line	:	2 SHERMAN POTTS DR
Second Line	:	SUITE 202
City	:	GHENT
State	:	NY
Zip	:	12075-3216
Country	:	US
Telephone Number	:	518-828-9500
Fax Number	:	518-828-9560

Authorized Official
Title or Position	:	ORGANIZER/OWNER
Name	:	MR. REAN JOHN DE LEON ENRIQUEZ
Credential	:	PT
Telephone Number	:	845-309-2594

Provider Enumeration Date	:	10/26/2009
Last Update Date	:	10/26/2009

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