MEDICARE: MID HUDSON PHYSICAL MEDICINE & REHABILITATION PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	19889963	NY

General Provider Information

NPI Number	:	1104049725
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MID HUDSON PHYSICAL MEDICINE & REHABILITATION PC

Provider Business Mailing Address
First Line	:	21 N PLANK RD
Second Line	:
City	:	NEWBURGH
State	:	NY
Zip	:	12550-2128
Country	:	US
Telephone Number	:	845-565-5943
Fax Number	:

Provider Business Practice Location Address
First Line	:	21 N PLANK RD
Second Line	:
City	:	NEWBURGH
State	:	NY
Zip	:	12550-2128
Country	:	US
Telephone Number	:	845-565-5943
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SUNITHA POLEPALLE
Credential	:	MD
Telephone Number	:	845-565-5943

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	10/27/2015

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