Provider Demographics
NPI:1265203525
Name:HUDSON, DONNIKA D (LMT)
Entity type:Individual
Prefix:
First Name:DONNIKA
Middle Name:D
Last Name:HUDSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 SAINT MARKS PL APT 611
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-1833
Mailing Address - Country:US
Mailing Address - Phone:347-424-5097
Mailing Address - Fax:
Practice Address - Street 1:1162 RARITAN RD FL 1
Practice Address - Street 2:
Practice Address - City:CLARK
Practice Address - State:NJ
Practice Address - Zip Code:07066-1311
Practice Address - Country:US
Practice Address - Phone:718-285-1928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist