Provider Demographics
NPI:1164632329
Name:HUDSON MEDICAL PC
Entity Type:Organization
Organization Name:HUDSON MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUBRAMANIUM
Authorized Official - Middle Name:E
Authorized Official - Last Name:KHANTHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:1201-888-4528
Mailing Address - Street 1:654 AVENUE C STE 301
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-3899
Mailing Address - Country:US
Mailing Address - Phone:201-339-4644
Mailing Address - Fax:201-339-0056
Practice Address - Street 1:654 AVENUE C STE 301
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-3899
Practice Address - Country:US
Practice Address - Phone:201-339-4644
Practice Address - Fax:201-339-0056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA27329174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty