Healthcare Provider Details

I. General information

NPI: 1811064520
Provider Name (Legal Business Name): ERIVER NEUROLOGY OF NEW YORK. LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 06/10/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WESTAGE BUSINESS CTR DR STE 324
FISHKILL NY
12524-2265
US

IV. Provider business mailing address

200 WESTAGE BUSINESS CTR DR STE 324
FISHKILL NY
12524-2265
US

V. Phone/Fax

Practice location:
  • Phone: 845-452-9750
  • Fax: 845-452-9751
Mailing address:
  • Phone: 845-452-9750
  • Fax: 845-452-9751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. KATHY RYAN
Title or Position: OFFICE MANAGER
Credential:
Phone: 845-452-9750