Provider Demographics
NPI:1376815043
Name:HUDSON SURGEONS PA
Entity Type:Organization
Organization Name:HUDSON SURGEONS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AFTAB
Authorized Official - Middle Name:A
Authorized Official - Last Name:KHAWAJA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-795-0101
Mailing Address - Street 1:142 PALISADE AVE
Mailing Address - Street 2:DOCTORS OFFICE BLDG. SUITE 108
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-1133
Mailing Address - Country:US
Mailing Address - Phone:201-795-0101
Mailing Address - Fax:201-795-3550
Practice Address - Street 1:142 PALISADE AVE
Practice Address - Street 2:DOCTORS OFFICE BLDG. SUITE 108
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-1133
Practice Address - Country:US
Practice Address - Phone:201-795-0101
Practice Address - Fax:201-795-3550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-27
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02713900208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D19341Medicare UPIN