Healthcare Provider Details

I. General information

NPI: 1366554594
Provider Name (Legal Business Name): ORANGE PEDIATRIC ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 MIDWAY PARK DRIVE
MIDDLETOWN NY
10940
US

IV. Provider business mailing address

400 MIDWAY PARK DRIVE
MIDDLETOWN NY
10940
US

V. Phone/Fax

Practice location:
  • Phone: 845-343-0728
  • Fax: 845-343-2087
Mailing address:
  • Phone: 845-343-0728
  • Fax: 845-343-2087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1604871
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number172449
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number224031
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number149775
License Number StateNY

VIII. Authorized Official

Name: DR. WILLIAM ANTHONY ROSE
Title or Position: MEDICAL DOCTOR
Credential: MD
Phone: 845-343-0728