Provider Demographics
NPI:1124420211
Name:HUDSON CHILDRENS HEART CENTER LLC
Entity type:Organization
Organization Name:HUDSON CHILDRENS HEART CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOTB
Authorized Official - Suffix:
Authorized Official - Credentials:MBBCH
Authorized Official - Phone:973-879-9106
Mailing Address - Street 1:3234 JOHN F KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-3419
Mailing Address - Country:US
Mailing Address - Phone:973-879-9106
Mailing Address - Fax:
Practice Address - Street 1:3234 JOHN F KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-3419
Practice Address - Country:US
Practice Address - Phone:973-879-9106
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-19
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Single Specialty