Healthcare Provider Details

I. General information

NPI: 1780850115
Provider Name (Legal Business Name): MARGARETVILLE NRS HME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2008
Last Update Date: 05/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42158 STATE HIGHWAY 28
MARGARETVILLE NY
12455-2826
US

IV. Provider business mailing address

42158 STATE HIGHWAY 28
MARGARETVILLE NY
12455-2826
US

V. Phone/Fax

Practice location:
  • Phone: 845-586-1800
  • Fax:
Mailing address:
  • Phone: 845-586-1800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number1226300N
License Number StateNY

VIII. Authorized Official

Name: MS. KELLY A MCGINNIS
Title or Position: DIRECTOR OF REVENUE CYCLE
Credential:
Phone: 845-943-6023