Healthcare Provider Details

I. General information

NPI: 1659666840
Provider Name (Legal Business Name): HUDSON VISTA MEDICAL,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2011
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 LAUREL AVE # LL1
CORNWALL NY
12518-1403
US

IV. Provider business mailing address

70 DUBOIS STREET 5TH FLOOR ADMINISTRATION
NEWBURGH NY
12550
US

V. Phone/Fax

Practice location:
  • Phone: 845-534-7080
  • Fax: 845-458-4435
Mailing address:
  • Phone: 845-458-4855
  • Fax: 845-458-4853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNY

VIII. Authorized Official

Name: MR. THOMAS GIBNEY
Title or Position: SECRETARY
Credential:
Phone: 845-568-2881