Healthcare Provider Details

I. General information

NPI: 1548650468
Provider Name (Legal Business Name): GREATER HUDSON VALLEY FAMILY HEALTH CER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2015
Last Update Date: 01/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 COMMERCIAL PL
NEWBURGH NY
12550-5306
US

IV. Provider business mailing address

3 COMMERCIAL PL
NEWBURGH NY
12550-5306
US

V. Phone/Fax

Practice location:
  • Phone: 845-220-2146
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KIMMARIE BECKWITH
Title or Position: LPN
Credential: LPN
Phone: 845-220-2146