Healthcare Provider Details

I. General information

NPI: 1376746115
Provider Name (Legal Business Name): NEWBURGH SURGICAL SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 09/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 GIBNEY AVENUE
NEWBURGH NY
12550
US

IV. Provider business mailing address

460 GIBNEY AVENUE
NEWBURGH NY
12550
US

V. Phone/Fax

Practice location:
  • Phone: 845-561-1850
  • Fax: 845-561-0180
Mailing address:
  • Phone: 845-561-1850
  • Fax: 845-561-0180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: PAUL REICHMAN
Title or Position: OWNER
Credential: MD
Phone: 845-561-1850