1083837595 NPI number — HUDSON VALLEY EMERGENCY PHYSICIAN SERVICES, PC

Table of content: (NPI 1083837595)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083837595 NPI number — HUDSON VALLEY EMERGENCY PHYSICIAN SERVICES, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HUDSON VALLEY EMERGENCY PHYSICIAN SERVICES, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
TRI-STATE EMERGENCY PHYSICIANS, PLLC
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083837595
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1005 ALICE DR
Provider Second Line Business Mailing Address:
APT 111
Provider Business Mailing Address City Name:
SUMTER
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29150-2445
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-973-2320
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
484 TEMPLE HILL RD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
NEW WINDSOR
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12553-5557
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-774-9115
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CAVANAUGH
Authorized Official First Name:
SEAN
Authorized Official Middle Name:
JOSEPH
Authorized Official Title or Position:
PHYSICIAN ASSISTANT
Authorized Official Telephone Number:
703-973-2320

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  011833 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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