Healthcare Provider Details

I. General information

NPI: 1104154897
Provider Name (Legal Business Name): NEWBURGH PODIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2009
Last Update Date: 10/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 GIDNEY AVE SUITE 3
NEWBURGH NY
12550-3116
US

IV. Provider business mailing address

450 GIDNEY AVE SUITE 3
NEWBURGH NY
12550-3116
US

V. Phone/Fax

Practice location:
  • Phone: 845-565-3331
  • Fax: 845-565-3351
Mailing address:
  • Phone: 845-565-3331
  • Fax: 845-565-3351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number006174
License Number StateNY

VIII. Authorized Official

Name: DR. AFSANA QADER
Title or Position: OWNER
Credential: D.P.M
Phone: 914-582-8018