Provider Demographics
NPI:1770173528
Name:HUDSON, ALISHA RENEE (MEDICAL ASSISTANT)
Entity type:Individual
Prefix:
First Name:ALISHA
Middle Name:RENEE
Last Name:HUDSON
Suffix:
Gender:F
Credentials:MEDICAL ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:382 CHAPMAN ST
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111-1502
Mailing Address - Country:US
Mailing Address - Phone:862-216-0419
Mailing Address - Fax:
Practice Address - Street 1:1182 STUYVESANT AVE
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-1057
Practice Address - Country:US
Practice Address - Phone:973-399-2600
Practice Address - Fax:973-399-5252
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor