Provider Demographics
NPI:1790985943
Name:DR. RENEE HUDECHECK, P. C.
Entity Type:Organization
Organization Name:DR. RENEE HUDECHECK, P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUDECHECK
Authorized Official - Suffix:
Authorized Official - Credentials:O D
Authorized Official - Phone:609-584-9090
Mailing Address - Street 1:3800 QUAKERBRIDGE RD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-1010
Mailing Address - Country:US
Mailing Address - Phone:609-584-9090
Mailing Address - Fax:
Practice Address - Street 1:3800 QUAKERBRIDGE RD
Practice Address - Street 2:SUITE10
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-1010
Practice Address - Country:US
Practice Address - Phone:609-584-9090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4627261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU26648Medicare PIN
NJ4539250001Medicare NSC