Healthcare Provider Details

I. General information

NPI: 1508851759
Provider Name (Legal Business Name): IRVELYNE CAMILLE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 HARRIS BUSHVILLE RD
HARRIS NY
12742
US

IV. Provider business mailing address

707 E MAIN ST
MIDDLETOWN NY
10940-2650
US

V. Phone/Fax

Practice location:
  • Phone: 845-333-8909
  • Fax:
Mailing address:
  • Phone: 845-333-7575
  • Fax: 845-333-4663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number234817
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: