1659666840 NPI number — HUDSON VISTA MEDICAL,PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659666840 NPI number — HUDSON VISTA MEDICAL,PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HUDSON VISTA MEDICAL,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:
Provider Other Organization Name Type Code:
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:
1659666840
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/28/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
70 DUBOIS STREET
Provider Second Line Business Mailing Address:
5TH FLOOR ADMINISTRATION
Provider Business Mailing Address City Name:
NEWBURGH
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12550
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-458-4855
Provider Business Mailing Address Fax Number:
845-458-4853

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1510 ROUTE 9W
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
MARLBORO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12542-5425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-795-5500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/15/2011

Additional Information

Authorized Official

Authorized Official Last Name:
GIBNEY
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
Authorized Official Title or Position:
SECRETARY
Authorized Official Telephone Number:
845-568-2881

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208600000X , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 03377979 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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