Provider Demographics
NPI:1346466257
Name:HUDSON MEDICAL LAB INC.
Entity Type:Organization
Organization Name:HUDSON MEDICAL LAB INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LAB DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:PRESTON
Authorized Official - Last Name:RIZZO
Authorized Official - Suffix:
Authorized Official - Credentials:HCLD
Authorized Official - Phone:201-339-5444
Mailing Address - Street 1:1029 AVENUE C
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-3217
Mailing Address - Country:US
Mailing Address - Phone:201-339-5444
Mailing Address - Fax:201-339-2517
Practice Address - Street 1:1029 AVENUE C
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-3217
Practice Address - Country:US
Practice Address - Phone:201-339-5444
Practice Address - Fax:201-339-2517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ31D0102853291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2593106-01Medicaid
NJ2593106-01Medicaid