Healthcare Provider Details

I. General information

NPI: 1235594672
Provider Name (Legal Business Name): MEDICAL ASSOCIATES OF THE HUDSON VALLEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2015
Last Update Date: 12/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 FOX ST STE. 200
POUGHKEEPSIE NY
12601-4732
US

IV. Provider business mailing address

360 WASHINGTON AVE
KINGSTON NY
12401-3702
US

V. Phone/Fax

Practice location:
  • Phone: 845-338-7140
  • Fax: 845-338-7141
Mailing address:
  • Phone: 845-338-7140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number208510
License Number StateNY

VIII. Authorized Official

Name: CRAIG MOSS
Title or Position: DIRECTOR
Credential: MD
Phone: 845-338-7140