1891972709 NPI number — SOMERS ORTHOPAEDIC SURGERY & SPORTS MED GROUP PLLC

Table of content: (NPI 1891972709)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891972709 NPI number — SOMERS ORTHOPAEDIC SURGERY & SPORTS MED GROUP PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOMERS ORTHOPAEDIC SURGERY & SPORTS MED GROUP PLLC
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:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1891972709
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
664 STONELEIGH AVE
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
CARMEL
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10512-3940
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-278-8400
Provider Business Mailing Address Fax Number:
845-278-4320

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 VICTORY CT
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:
12550-1745
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-565-1454
Provider Business Practice Location Address Fax Number:
845-565-9803
Provider Enumeration Date:
01/23/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BUCHALTER
Authorized Official First Name:
JOEL
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
845-278-8400

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , 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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