Provider Demographics
NPI:1184656829
Name:HUDSON RIVER RADIOLOGY CENTER LLC
Entity Type:Organization
Organization Name:HUDSON RIVER RADIOLOGY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FERAS
Authorized Official - Middle Name:
Authorized Official - Last Name:JALOUDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-656-5050
Mailing Address - Street 1:PO BOX 1814
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD CLIFFS
Mailing Address - State:NJ
Mailing Address - Zip Code:07632
Mailing Address - Country:US
Mailing Address - Phone:201-656-5050
Mailing Address - Fax:800-706-0381
Practice Address - Street 1:120-152 48TH STREET
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087
Practice Address - Country:US
Practice Address - Phone:201-330-1606
Practice Address - Fax:201-330-7622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ239512085R0202X, 261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0071561Medicaid
NJ0516872Medicaid
NJ094715OtherPTAN