Healthcare Provider Details

I. General information

NPI: 1093723264
Provider Name (Legal Business Name): RICHARD A. BORDOWITZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 NORTH HAMILTON HUDSON RIVER HEALTHCARE, INC.
POUGHKEEPSIE NY
12601
US

IV. Provider business mailing address

1200 BROWN ST FL 4 HUDSON RIVER HEALTHCARE, INC.
PEEKSKILL NY
10566-3617
US

V. Phone/Fax

Practice location:
  • Phone: 845-454-8204
  • Fax: 845-454-8247
Mailing address:
  • Phone: 914-734-8858
  • Fax: 914-734-8745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number214219
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: