Healthcare Provider Details

I. General information

NPI: 1659303410
Provider Name (Legal Business Name): FRED S HURST MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: FRED S HURST M.D.

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 08/24/2021
Certification Date: 08/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200WESTAGE BUINESS CENTER SUITE324
FISHKILL NY
12524
US

IV. Provider business mailing address

200 WESTAGE BUSINESS CTR DR SUITE 324
FISHKILL NY
12524-2264
US

V. Phone/Fax

Practice location:
  • Phone: 845-896-0611
  • Fax: 845-896-0616
Mailing address:
  • Phone: 845-896-0611
  • Fax: 845-896-0616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number091385
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: