Healthcare Provider Details

I. General information

NPI: 1477673739
Provider Name (Legal Business Name): HUDSON VALLEY OTOLARYNGOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 READE PL DYSON CENTER 3RD FLOOR
POUGHKEEPSIE NY
12601-3947
US

IV. Provider business mailing address

45 READE PL DYSON CENTER 3RD FLOOR
POUGHKEEPSIE NY
12601-3947
US

V. Phone/Fax

Practice location:
  • Phone: 845-471-4086
  • Fax:
Mailing address:
  • Phone: 845-471-4086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: CAROL BAILEY
Title or Position: OFFICE MGR
Credential:
Phone: 845-471-4086