Provider Demographics
NPI:1588749378
Name:HUDSON THERAPY
Entity type:Organization
Organization Name:HUDSON THERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SPENCER
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:MALKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-815-2299
Mailing Address - Street 1:280 S HARRISON ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-1960
Mailing Address - Country:US
Mailing Address - Phone:973-678-1600
Mailing Address - Fax:973-678-1699
Practice Address - Street 1:280 S HARRISON ST
Practice Address - Street 2:SUITE 201
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-1960
Practice Address - Country:US
Practice Address - Phone:973-678-1600
Practice Address - Fax:973-678-1699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ063647261QM1300X
NJ22934261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Not Answered261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ063647Medicare ID - Type UnspecifiedMULTI SPECIALTY GROUP
NJ314519Medicare ID - Type UnspecifiedCORF