Healthcare Provider Details

I. General information

NPI: 1013035112
Provider Name (Legal Business Name): PLANNED PARENTHOOD OF THE MID-HUDSON VALLEY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 09/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 LAKE ST SUITE 11
NEWBURGH NY
12550-5245
US

IV. Provider business mailing address

178 CHURCH STREET
POUGHKEEPSIE NY
12601
US

V. Phone/Fax

Practice location:
  • Phone: 845-471-1530
  • Fax: 845-471-1519
Mailing address:
  • Phone: 845-471-1530
  • Fax: 845-471-1519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0005X
TaxonomyAmbulatory Family Planning Facility
License Number1302207R
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number1302207R
License Number StateNY

VIII. Authorized Official

Name: MS. MARY DOROTHY RADFORD
Title or Position: VP OF FINANCE
Credential: CPA
Phone: 845-471-1530