Provider Demographics
NPI:1477717353
Name:HUDSON PAIN MANAGEMENT AND REHAB MEDICAL PC
Entity Type:Organization
Organization Name:HUDSON PAIN MANAGEMENT AND REHAB MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHANG
Authorized Official - Middle Name:H
Authorized Official - Last Name:KANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-894-4787
Mailing Address - Street 1:464 HUDSON TERRACE
Mailing Address - Street 2:SUITE G102
Mailing Address - City:ENGLEWOOD CLIFFS
Mailing Address - State:NJ
Mailing Address - Zip Code:07632
Mailing Address - Country:US
Mailing Address - Phone:201-894-4787
Mailing Address - Fax:201-894-4786
Practice Address - Street 1:464 HUDSON TERRACE
Practice Address - Street 2:SUITE G102
Practice Address - City:ENGLEWOOD CLIFFS
Practice Address - State:NJ
Practice Address - Zip Code:07632
Practice Address - Country:US
Practice Address - Phone:201-894-4787
Practice Address - Fax:201-894-4786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-10
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ130330Medicare UPIN