1689669079 NPI number — CORNERSTONE FAMILY HEALTHCARE

Table of content: (NPI 1689669079)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689669079 NPI number — CORNERSTONE FAMILY HEALTHCARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CORNERSTONE FAMILY HEALTHCARE
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:
THE GREATER HUDSON VALLEY FAMILY HEALTH CENTER, INC.
Provider Other Organization Name Type Code:
4
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:
1689669079
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/30/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2570 ROUTE 9W
Provider Second Line Business Mailing Address:
SUITE 10
Provider Business Mailing Address City Name:
CORNWALL
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12518-1323
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-220-3100
Provider Business Mailing Address Fax Number:
845-534-2940

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
147 LAKE STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWBURGH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12550-5242
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-563-8000
Provider Business Practice Location Address Fax Number:
845-563-8093
Provider Enumeration Date:
09/13/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MURPHY
Authorized Official First Name:
PAT
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
845-220-3130

Provider Taxonomy Codes

  • Taxonomy code: 332S00000X , with the licence number:  000425 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: WCW271 . This is a "MEDICARE ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00472931 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 331832 . This is a "MEDICARE ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".