Healthcare Provider Details

I. General information

NPI: 1497696546
Provider Name (Legal Business Name): MR. GLENROY ADAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 LENT ST
POUGHKEEPSIE NY
12601-2616
US

IV. Provider business mailing address

46 LENT ST
POUGHKEEPSIE NY
12601-2616
US

V. Phone/Fax

Practice location:
  • Phone: 845-656-4610
  • Fax:
Mailing address:
  • Phone:
  • Fax: 845-485-0210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number30767LY
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: