Healthcare Provider Details

I. General information

NPI: 1568550572
Provider Name (Legal Business Name): PROFESSIONAL OBS-GYN OF ORANGE CO LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 CRYSTAL RUN RD SUITE 202
MIDDLETOWN NY
10941-7000
US

IV. Provider business mailing address

75 CRYSTAL RUN RD SUITE 202
MIDDLETOWN NY
10941-7000
US

V. Phone/Fax

Practice location:
  • Phone: 845-703-5000
  • Fax: 845-703-5010
Mailing address:
  • Phone: 845-703-5000
  • Fax: 845-703-5010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNY

VIII. Authorized Official

Name: DR. RALPH GEORGE ANDERSON
Title or Position: HEAD DOCTOR
Credential: M.D.
Phone: 845-703-5000