Healthcare Provider Details

I. General information

NPI: 1083883458
Provider Name (Legal Business Name): EXODUSHEALTH MEDICAL, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2008
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 STATE ROUTE 208
MONROE NY
10950-4648
US

IV. Provider business mailing address

420 E MAIN ST
MIDDLETOWN NY
10940-2516
US

V. Phone/Fax

Practice location:
  • Phone: 845-281-5009
  • Fax: 845-231-6078
Mailing address:
  • Phone: 845-294-2595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number212042
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DENISE REIDY-KNIGHT
Title or Position: ENROLLMENT SUPERVISOR
Credential:
Phone: 845-551-9673