Healthcare Provider Details

I. General information

NPI: 1508566670
Provider Name (Legal Business Name): HERITAGE MEDICAL SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2023
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

695 DUTCHESS TPKE STE 104
POUGHKEEPSIE NY
12603-6443
US

IV. Provider business mailing address

695 DUTCHESS TPKE STE 104
POUGHKEEPSIE NY
12603-6443
US

V. Phone/Fax

Practice location:
  • Phone: 404-242-9621
  • Fax: 732-347-3388
Mailing address:
  • Phone: 404-242-9621
  • Fax: 732-347-3388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: STEVE O ODEH
Title or Position: OWNER
Credential:
Phone: 404-242-9621