Provider Demographics
NPI:1073551016
Name:ESSEX HUDSON UROLOGY PC
Entity type:Organization
Organization Name:ESSEX HUDSON UROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MINCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-225-9254
Mailing Address - Street 1:PO BOX 550
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-0550
Mailing Address - Country:US
Mailing Address - Phone:201-225-9254
Mailing Address - Fax:201-225-9254
Practice Address - Street 1:256 BROAD ST
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-2766
Practice Address - Country:US
Practice Address - Phone:973-743-4450
Practice Address - Fax:973-429-9076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
020391Medicare ID - Type Unspecified