Provider Demographics
NPI:1316246051
Name:HUDSON PAIN AND REHAB LLC
Entity type:Organization
Organization Name:HUDSON PAIN AND REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUADA
Authorized Official - Middle Name:AMIN
Authorized Official - Last Name:NOOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-322-9495
Mailing Address - Street 1:711 KEARNY AVE
Mailing Address - Street 2:
Mailing Address - City:KEARNY
Mailing Address - State:NJ
Mailing Address - Zip Code:07032-3003
Mailing Address - Country:US
Mailing Address - Phone:301-520-5151
Mailing Address - Fax:301-322-9696
Practice Address - Street 1:711 KEARNY AVE
Practice Address - Street 2:
Practice Address - City:KEARNY
Practice Address - State:NJ
Practice Address - Zip Code:07032-3003
Practice Address - Country:US
Practice Address - Phone:301-520-5151
Practice Address - Fax:301-322-9696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD216682261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy