Healthcare Provider Details

I. General information

NPI: 1609868355
Provider Name (Legal Business Name): KENNETH NEWMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 08/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 EAST MAIN STREET ANESTHESIA DEPT
PORT JERVIS NY
12771-2253
US

IV. Provider business mailing address

40 DELANO DR
RHINEBECK NY
12572
US

V. Phone/Fax

Practice location:
  • Phone: 845-357-5775
  • Fax: 845-357-5777
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number196313
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: