Healthcare Provider Details

I. General information

NPI: 1306184908
Provider Name (Legal Business Name): HURLEY AVENUE FAMILY MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2013
Last Update Date: 01/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 HURLEY AVE
KINGSTON NY
12401-2400
US

IV. Provider business mailing address

211 HURLEY AVE
KINGSTON NY
12401-2400
US

V. Phone/Fax

Practice location:
  • Phone: 845-339-2804
  • Fax: 845-338-5982
Mailing address:
  • Phone: 845-339-2804
  • Fax: 845-338-5982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number129228
License Number StateNY

VIII. Authorized Official

Name: JENNIFER HAMILTON
Title or Position: OFFICE MANAGER
Credential:
Phone: 845-340-1185