Provider Demographics
NPI:1780712570
Name:HUDSON PAIN AND ORTHOPEDIC ASSOCIATES, LLC
Entity type:Organization
Organization Name:HUDSON PAIN AND ORTHOPEDIC ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:TIRADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:2014-531-5555
Mailing Address - Street 1:6035 BLVD. EAST
Mailing Address - Street 2:
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093
Mailing Address - Country:US
Mailing Address - Phone:201-453-1555
Mailing Address - Fax:201-453-9841
Practice Address - Street 1:6035 KENNEDY BLVD E
Practice Address - Street 2:
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-3834
Practice Address - Country:US
Practice Address - Phone:201-453-1555
Practice Address - Fax:201-453-9841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04585100174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty