Provider Demographics
NPI:1639286735
Name:HUDSON IMAGING PA
Entity type:Organization
Organization Name:HUDSON IMAGING PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAMAL
Authorized Official - Middle Name:C
Authorized Official - Last Name:GREISS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-369-1900
Mailing Address - Street 1:75 MONTGOMERY STREET
Mailing Address - Street 2:SUITE 401
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302
Mailing Address - Country:US
Mailing Address - Phone:201-369-1900
Mailing Address - Fax:201-369-9300
Practice Address - Street 1:75 MONTGOMERY STREET
Practice Address - Street 2:SUITE 401
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302
Practice Address - Country:US
Practice Address - Phone:201-369-1900
Practice Address - Fax:201-369-9300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ23417261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
101408OtherAMERIGROUP
2964536OtherAETNA HMO
7249376OtherAETNA ALL OTHERS
NJ8820902Medicaid
W1L831OtherWELLCHOICE
1412491OtherAMERIHEALTH PPO
2099468000OtherAMERIHEALTH HMO
8820902OtherUNISYS
A2839370OtherOXFORD
056977OtherRAILROAD MEDICARE PIN
NJ1171229OtherHORIZON NJ HEALTH MERCY
NJHUL00020901OtherAMERICHOICE
7249376OtherAETNA
1412491OtherAMERIHEALTH PPO