Provider Demographics
NPI:1376738765
Name:HUDSON DIGESTIVE HEALTH CENTER PA
Entity Type:Organization
Organization Name:HUDSON DIGESTIVE HEALTH CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANAKA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRAKASH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-858-8444
Mailing Address - Street 1:534 AVENUE E
Mailing Address - Street 2:SUITE 1-A
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-3987
Mailing Address - Country:US
Mailing Address - Phone:201-858-8444
Mailing Address - Fax:201-858-4260
Practice Address - Street 1:534 AVENUE E
Practice Address - Street 2:SUITE 1-A
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-3987
Practice Address - Country:US
Practice Address - Phone:201-858-8444
Practice Address - Fax:201-858-4260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJDB8213OtherMEDICARE PTAN
NJ055398Medicare PIN