Healthcare Provider Details

I. General information

NPI: 1750727632
Provider Name (Legal Business Name): SEAPORT ORTHOPAEDIC ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2013
Last Update Date: 05/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 ROBINSON AVE
NEWBURGH NY
12550-3353
US

IV. Provider business mailing address

19 BEEKMAN ST
NEW YORK NY
10038-1531
US

V. Phone/Fax

Practice location:
  • Phone: 845-562-3600
  • Fax: 845-562-3679
Mailing address:
  • Phone: 212-513-7711
  • Fax: 212-964-4861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY GOLDSTEIN
Title or Position: SHARE HOLDER
Credential: MD
Phone: 212-513-7711