Healthcare Provider Details

I. General information

NPI: 1093853079
Provider Name (Legal Business Name): HUDSON VALLEY ORTHOPEDIC CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 11/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

367 BROADWAY
KINGSTON NY
12401
US

IV. Provider business mailing address

367 BROADWAY
KINGSTON NY
12401
US

V. Phone/Fax

Practice location:
  • Phone: 845-339-6122
  • Fax: 845-339-6716
Mailing address:
  • Phone: 845-339-6122
  • Fax: 845-339-6716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number138703-1
License Number StateNY

VIII. Authorized Official

Name: JOHN V IOIA
Title or Position: PRESIDENT
Credential: MD
Phone: 845-339-6122