Healthcare Provider Details

I. General information

NPI: 1699063073
Provider Name (Legal Business Name): ENHANCED MEDICAL CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2011
Last Update Date: 07/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 LAKE ST
LIBERTY NY
12754-1966
US

IV. Provider business mailing address

75 HERRICK AVE # 201
SPRING VALLEY NY
10977-3818
US

V. Phone/Fax

Practice location:
  • Phone: 845-826-0060
  • Fax:
Mailing address:
  • Phone: 845-826-0060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number107113
License Number StateNY

VIII. Authorized Official

Name: DAVID HALDORSEN
Title or Position: OWNER
Credential: MD
Phone: 845-826-0060