Healthcare Provider Details

I. General information

NPI: 1336187426
Provider Name (Legal Business Name): ORTHOPEDICS & SPORTS MEDICINE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 04/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 BLOOMING GROVE TPKE
NEW WINDSOR NY
12553-7769
US

IV. Provider business mailing address

219 BLOOMING GROVE TPKE
NEW WINDSOR NY
12553-7769
US

V. Phone/Fax

Practice location:
  • Phone: 845-561-8060
  • Fax: 845-561-8523
Mailing address:
  • Phone: 845-561-8060
  • Fax: 845-561-8523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number209883-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number026213
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number006544
License Number StateNY

VIII. Authorized Official

Name: DR. BARRY HYMAN
Title or Position: PARTNER
Credential: MD
Phone: 845-561-8060