Provider Demographics
NPI:1518021039
Name:HUDSON TERRACE MEDICAL, P.A.
Entity Type:Organization
Organization Name:HUDSON TERRACE MEDICAL, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TAEWON
Authorized Official - Middle Name:
Authorized Official - Last Name:MOON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-503-0066
Mailing Address - Street 1:464 HUDSON TERRACE
Mailing Address - Street 2:SUITE #102
Mailing Address - City:ENGLEWOOD CLIFFS
Mailing Address - State:NJ
Mailing Address - Zip Code:07632-2917
Mailing Address - Country:US
Mailing Address - Phone:201-503-0066
Mailing Address - Fax:201-503-0190
Practice Address - Street 1:464 HUDSON TERRACE
Practice Address - Street 2:SUITE #102
Practice Address - City:ENGLEWOOD CLIFFS
Practice Address - State:NJ
Practice Address - Zip Code:07632-2917
Practice Address - Country:US
Practice Address - Phone:201-503-0066
Practice Address - Fax:201-503-0190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05670900261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical