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General NPI Number Information
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NPI Number | 1730380932
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Entity Type | Organization
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Legal Business Name | ORANGETOWN OPHTHALMOLOGY NY PC
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Dates
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Enumeration Date | 05/29/2007
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Last Update Date | 03/18/2014
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Provider Practice Location Address
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Address Line | 2 CROSFIELD AVE STE 315
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City | WEST NYACK
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State | NY
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Zip | 10994-2220
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Country | US
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Telephone | 845-348-3400
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Fax | 348-348-3438
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Provider Business Mailing Address
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Address Line | 2 CROSFIELD AVE STE 315
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City | WEST NYACK
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State | NY
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Zip | 10994-2220
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Country | US
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Telephone | 845-348-3400
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Fax | 348-348-3438
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Authorized Official
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Title or Position | MD/OWNER
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Name | DR. KIMBALL PRATT WOODWARD
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Credential | MD
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Telephone | 845-348-3400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 167622
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License Number State | NY
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