Healthcare Provider Details

I. General information

NPI: 1962810788
Provider Name (Legal Business Name): JUDITH FOINMBAMTITA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2014
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 MANCHESTER RD STE 105
POUGHKEEPSIE NY
12603-2587
US

IV. Provider business mailing address

301 MANCHESTER RD STE 105
POUGHKEEPSIE NY
12603-2587
US

V. Phone/Fax

Practice location:
  • Phone: 845-452-1700
  • Fax: 845-452-1752
Mailing address:
  • Phone: 845-452-1700
  • Fax: 845-452-1752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number683185-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: