Healthcare Provider Details

I. General information

NPI: 1588044309
Provider Name (Legal Business Name): NEW GENERATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2015
Last Update Date: 06/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1545 ROUTE 52
FISHKILL NY
12524-1627
US

IV. Provider business mailing address

1545 ROUTE 52
FISHKILL NY
12524-1627
US

V. Phone/Fax

Practice location:
  • Phone: 845-896-2327
  • Fax:
Mailing address:
  • Phone: 845-896-2327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number21NE1023382
License Number StateNY

VIII. Authorized Official

Name: MARIA FREDERICK
Title or Position: OWNER
Credential:
Phone: 845-896-2327