Healthcare Provider Details

I. General information

NPI: 1154856896
Provider Name (Legal Business Name): PREMIER MEDICAL GROUP OF THE HUDSON VALLEY P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2017
Last Update Date: 01/29/2020
Certification Date: 01/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 EASTDALE AVE N
POUGHKEEPSIE NY
12603
US

IV. Provider business mailing address

243 NORTH RD SUITE 304
POUGHKEEPSIE NY
12601-1172
US

V. Phone/Fax

Practice location:
  • Phone: 845-437-5000
  • Fax:
Mailing address:
  • Phone: 845-451-7251
  • Fax: 845-471-7372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SUNIL KHURANA
Title or Position: CEO
Credential: MD
Phone: 845-471-9410