Healthcare Provider Details

I. General information

NPI: 1154365765
Provider Name (Legal Business Name): JUAN DARDATI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 05/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ORANGE REGIONAL MEDICAL CENTER - HORTON CAMPUS 60 PROSPECT AVE
MIDDLETOWN NY
10940
US

IV. Provider business mailing address

PO BOX 511
GOSHEN NY
10924-0511
US

V. Phone/Fax

Practice location:
  • Phone: 845-342-7156
  • Fax:
Mailing address:
  • Phone: 845-294-4339
  • Fax: 845-294-4333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number098213
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: