Provider Demographics
NPI:1295068278
Name:HUDSON RIVER ORTHODONTICS, PC
Entity type:Organization
Organization Name:HUDSON RIVER ORTHODONTICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SAJU
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHEW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:212-580-1140
Mailing Address - Street 1:220 RIVERSIDE BLVD
Mailing Address - Street 2:DENTAL OFFICE
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10069-1001
Mailing Address - Country:US
Mailing Address - Phone:212-580-1140
Mailing Address - Fax:212-954-5583
Practice Address - Street 1:220 RIVERSIDE BLVD
Practice Address - Street 2:DENTAL OFFICE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10069-1001
Practice Address - Country:US
Practice Address - Phone:212-580-1140
Practice Address - Fax:212-954-5583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-09
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0507111223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty