Provider Demographics
NPI:1306903984
Name:HUDSON INTERNAL MEDICINE ASSOC PC
Entity type:Organization
Organization Name:HUDSON INTERNAL MEDICINE ASSOC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SENIOR PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:P
Authorized Official - Last Name:CARDIELLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-436-8888
Mailing Address - Street 1:744 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002
Mailing Address - Country:US
Mailing Address - Phone:201-436-8888
Mailing Address - Fax:201-436-6644
Practice Address - Street 1:744 BROADWAY
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002
Practice Address - Country:US
Practice Address - Phone:201-436-8888
Practice Address - Fax:201-436-6644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07147100207R00000X
NJ25MB05725900207R00000X
NJ25MA04592300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1180908Medicaid
NJ067095NU2Medicare ID - Type Unspecified
NJ1180908Medicaid
C62892Medicare UPIN
H79292Medicare UPIN
F99797Medicare UPIN
NJ628354NU2Medicare ID - Type Unspecified