Healthcare Provider Details

I. General information

NPI: 1376854810
Provider Name (Legal Business Name): LISA A. OCHS RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2010
Last Update Date: 06/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 ORANGE AVE HUDSON RIVER HEALTHCARE, INC.
WALDEN NY
12586-1816
US

IV. Provider business mailing address

1037 MAIN ST ATTN: CREDENTIALING
PEEKSKILL NY
10566-2950
US

V. Phone/Fax

Practice location:
  • Phone: 845-778-2700
  • Fax: 845-778-2945
Mailing address:
  • Phone: 914-734-8800
  • Fax: 914-734-8786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number018061
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: