Provider Demographics
NPI:1215933775
Name:HUDSON THERAPY, LLC
Entity type:Organization
Organization Name:HUDSON THERAPY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SPENCER
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:MALKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:917-815-2299
Mailing Address - Street 1:9225 KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-5361
Mailing Address - Country:US
Mailing Address - Phone:201-869-2707
Mailing Address - Fax:201-869-2717
Practice Address - Street 1:9225 KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-5361
Practice Address - Country:US
Practice Address - Phone:201-869-2707
Practice Address - Fax:201-869-2717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ063647261QM1300X
NJ22872261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ063647Medicare PIN
NJ314507Medicare Oscar/Certification