Provider Demographics
NPI:1497066476
Name:HUDSON INTERNAL MEDICINE, PA
Entity Type:Organization
Organization Name:HUDSON INTERNAL MEDICINE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEA KEUN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-222-8288
Mailing Address - Street 1:550 NEWARK AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-1326
Mailing Address - Country:US
Mailing Address - Phone:201-222-8288
Mailing Address - Fax:201-222-8265
Practice Address - Street 1:550 NEWARK AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-1326
Practice Address - Country:US
Practice Address - Phone:201-222-8288
Practice Address - Fax:201-222-8265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-24
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05669400207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1453618-001OtherCIGNA HMO
NJ5173809Medicaid
4226989OtherAETNA
110147933OtherPALMETTO GBA - RAILROAD MEDICARE
2501688OtherGHI
4121011OtherCIGNA
J1904OtherHORIZON BCBS - NJ
10G451OtherEMPIRE BCBS
140137OtherUS HEALTHCARE
NJ691768OtherMEDICARE - LEGACY #
392388OtherWELLCARE
1094921OtherUNITED HEALTHCARE
HP063OtherOXFORD
HP063OtherOXFORD