Healthcare Provider Details

I. General information

NPI: 1194090878
Provider Name (Legal Business Name): CRITICAL CARE MEDICAL MANAGEMENT ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2012
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 N BROADWAY
SLEEPY HOLLOW NY
10591-1020
US

IV. Provider business mailing address

PO BOX 631798
CINCINNATI OH
45263-1798
US

V. Phone/Fax

Practice location:
  • Phone: 914-366-3000
  • Fax:
Mailing address:
  • Phone: 845-702-2711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: LAURIE LADUCA
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 845-702-2711