Basic Information
| Provider Information | |||||||||
| NPI: | 1740720614 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HUDSON RIVER BRACES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 810 ABBOTT BLVD | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | FORT LEE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070244151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2012243600 | ||||||||
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| Practice Location | |||||||||
| Address1: | 810 ABBOTT BLVD | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | FORT LEE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070244151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2012243600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2017 | ||||||||
| LastUpdateDate: | 02/27/2017 | ||||||||
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| AuthorizedOfficialLastName: | GANDIA | ||||||||
| AuthorizedOfficialFirstName: | CASSANDRA | ||||||||
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| AuthorizedOfficialTitleorPosition: | ORTHODONTIST | ||||||||
| AuthorizedOfficialTelephone: | 2017743344 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.D.S. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223X0400X | 22DI02575602 | NJ | Y | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist | Orthodontics and Dentofacial Orthopedics |
No ID Information.