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General NPI Number Information
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NPI Number | 1487694345
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Entity Type | Organization
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Legal Business Name | BON SECOURS CHARITY HEALTH SYSTEM MEDICAL GROUP, P.C.
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Dates
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Enumeration Date | 06/08/2006
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Last Update Date | 07/14/2021
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Provider Practice Location Address
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Address Line | 20 GRAND ST 3RD FLOOR
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City | WARWICK
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State | NY
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Zip | 10990-1035
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Country | US
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Telephone | 845-987-3906
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Fax | 845-987-5979
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Provider Business Mailing Address
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Address Line | 20 GRAND ST 3RD FLOOR
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City | WARWICK
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State | NY
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Zip | 10990-1035
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Country | US
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Telephone | 845-987-3906
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Fax | 845-987-5979
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | LAURI QUIGLEY
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Credential |
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Telephone | 845-987-3906
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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