MEDICARE: ERH SPECIALTY PRACTICE

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	207RC0000X	Cardiovascular Disease Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265499602
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ERH SPECIALTY PRACTICE

Provider Business Mailing Address
First Line	:	PO BOX 2038
Second Line	:
City	:	NEW CITY
State	:	NY
Zip	:	10956
Country	:	US
Telephone Number	:	845-638-9079
Fax Number	:	845-638-9079

Provider Business Practice Location Address
First Line	:	ROUTE 209
Second Line	:	ELLENVILLE REGIONAL HOSPITAL
City	:	ELLENVILLE
State	:	NY
Zip	:	12428
Country	:	US
Telephone Number	:	845-647-6400
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. STEVEN KELLEY
Credential	:
Telephone Number	:	845-647-6400

Provider Enumeration Date	:	04/28/2006
Last Update Date	:	11/24/2007

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Directions to “ERH SPECIALTY PRACTICE ” Practice Location

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