Healthcare Provider Details

I. General information

NPI: 1265432736
Provider Name (Legal Business Name): STEVEN L VENTRUDO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2005
Last Update Date: 04/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 ROUTE 303
TAPPAN NY
10983-2514
US

IV. Provider business mailing address

155 CRYSTAL RUN RD
MIDDLETOWN NY
10941-4028
US

V. Phone/Fax

Practice location:
  • Phone: 845-359-5005
  • Fax: 845-359-7890
Mailing address:
  • Phone: 845-703-6999
  • Fax: 845-703-6297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number166157-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: