Healthcare Provider Details

I. General information

NPI: 1174789812
Provider Name (Legal Business Name): RIVERVIEW PSYCHIATRIC MEDICINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2008
Last Update Date: 08/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 VIOLET AVE
POUGHKEEPSIE NY
12601-1034
US

IV. Provider business mailing address

370 VIOLET AVE
POUGHKEEPSIE NY
12601-1034
US

V. Phone/Fax

Practice location:
  • Phone: 845-471-1807
  • Fax: 845-471-1815
Mailing address:
  • Phone: 845-471-1807
  • Fax: 845-471-1815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number166228
License Number StateNY

VIII. Authorized Official

Name: DR. RANDY IAN PARDELL
Title or Position: PRESIDENT/DIRECTOR
Credential: M.D.
Phone: 845-471-1807