Provider Demographics
NPI:1194154716
Name:HUDSON PREMIER PT, LLC
Entity type:Organization
Organization Name:HUDSON PREMIER PT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA GAIL
Authorized Official - Middle Name:F
Authorized Official - Last Name:FRAYNA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:201-766-1728
Mailing Address - Street 1:4800 BROADWAY, SUITE 212
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087
Mailing Address - Country:US
Mailing Address - Phone:201-766-1728
Mailing Address - Fax:888-503-1237
Practice Address - Street 1:4800 BROADWAY, SUITE 212
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087
Practice Address - Country:US
Practice Address - Phone:201-766-1728
Practice Address - Fax:888-503-1237
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHYSICAL THERAPY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01224200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty