Healthcare Provider Details

I. General information

NPI: 1013180942
Provider Name (Legal Business Name): HOSPITAL EMERGENCY LICENSED PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2008
Last Update Date: 04/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 LAUREL AVE
CORNWALL NY
12518-1403
US

IV. Provider business mailing address

484 TEMPLE HILL RD STE 102
NEW WINDSOR NY
12553-5557
US

V. Phone/Fax

Practice location:
  • Phone: 845-534-7711
  • Fax:
Mailing address:
  • Phone: 845-565-3700
  • Fax: 845-565-3395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: GERALD A NERI
Title or Position: PRES
Credential: MD
Phone: 845-565-3700