Provider Demographics
NPI:1437210820
Name:MATVALS CORP
Entity Type:Organization
Organization Name:MATVALS CORP
Other - Org Name:HUDSON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:R.PH IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHEW
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:201-432-5205
Mailing Address - Street 1:2260 JOHN F KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07304-1462
Mailing Address - Country:US
Mailing Address - Phone:201-432-5205
Mailing Address - Fax:201-432-2578
Practice Address - Street 1:2260 JOHN F KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07304-1462
Practice Address - Country:US
Practice Address - Phone:201-432-5205
Practice Address - Fax:201-432-2578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRI020106183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5127505Medicaid
NJ3876900001Medicare NSC