Provider Demographics
NPI:1881742542
Name:HUDSON PRIMARY CARE ASSOCIATES,LLC
Entity type:Organization
Organization Name:HUDSON PRIMARY CARE ASSOCIATES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:V
Authorized Official - Last Name:RAFFAELLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-948-8828
Mailing Address - Street 1:1265 PATERSON PLANK RD
Mailing Address - Street 2:
Mailing Address - City:SECAUCUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07094-3242
Mailing Address - Country:US
Mailing Address - Phone:201-348-8828
Mailing Address - Fax:201-348-0026
Practice Address - Street 1:1265 PATERSON PLANK RD
Practice Address - Street 2:
Practice Address - City:SECAUCUS
Practice Address - State:NJ
Practice Address - Zip Code:07094-3242
Practice Address - Country:US
Practice Address - Phone:201-348-8828
Practice Address - Fax:201-348-0026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA36099207Q00000X
NJMA42512207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ440097PK4Medicare ID - Type Unspecified
NJC56929Medicare UPIN
NJ536619PK4Medicare ID - Type Unspecified
NJC54449Medicare UPIN