Healthcare Provider Details

I. General information

NPI: 1255617254
Provider Name (Legal Business Name): ORANGE/ULSTER BOCES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2011
Last Update Date: 10/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 GIBSON RD
GOSHEN NY
10924-6709
US

IV. Provider business mailing address

6 LEDGER VIEW CT
HIGHLAND MILLS NY
10930-6816
US

V. Phone/Fax

Practice location:
  • Phone: 845-291-0100
  • Fax: 845-291-0212
Mailing address:
  • Phone: 845-291-0100
  • Fax: 845-291-0212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number072134-1
License Number StateNY

VIII. Authorized Official

Name: MR. SCOTT MORGANO
Title or Position: TEAM LEADER
Credential:
Phone: 845-291-0100