Provider Demographics
NPI:1073560207
Name:HUDSON MEDICAL AND MENTAL HEALTH INTEGRATED SERVICES, LLC
Entity Type:Organization
Organization Name:HUDSON MEDICAL AND MENTAL HEALTH INTEGRATED SERVICES, LLC
Other - Org Name:HUDSON MEDICAL AND MENTAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:FERNANDO
Authorized Official - Last Name:JARAMILLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-295-3033
Mailing Address - Street 1:301 60TH ST
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-5422
Mailing Address - Country:US
Mailing Address - Phone:201-295-3033
Mailing Address - Fax:201-295-8592
Practice Address - Street 1:301 60TH ST
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-5422
Practice Address - Country:US
Practice Address - Phone:201-295-3033
Practice Address - Fax:201-295-8592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07560000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty