Provider Demographics
NPI:1669662193
Name:HUDSON, ANGELA GALASSO (DC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:GALASSO
Last Name:HUDSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 IRON GATE RD
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-2475
Mailing Address - Country:US
Mailing Address - Phone:609-519-9392
Mailing Address - Fax:
Practice Address - Street 1:100 BRICK RD
Practice Address - Street 2:SUITE 215
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-2146
Practice Address - Country:US
Practice Address - Phone:856-334-5810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-31
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC38004712111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAGA789970OtherBLUECROSS/BLUESHIELD PROV
PAU57017Medicare UPIN
PAGA717081Medicare UPIN