Provider Demographics
NPI:1679134860
Name:HUDSON HEIGHTS ACO, INC
Entity Type:Organization
Organization Name:HUDSON HEIGHTS ACO, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BIENVENIDO
Authorized Official - Middle Name:
Authorized Official - Last Name:FAJARDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-417-0500
Mailing Address - Street 1:140 WADSWORTH AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-4817
Mailing Address - Country:US
Mailing Address - Phone:646-417-0500
Mailing Address - Fax:
Practice Address - Street 1:140 WADSWORTH AVE APT 4
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-4817
Practice Address - Country:US
Practice Address - Phone:646-417-0500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-27
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty