MEDICARE: EXODUSHEALTH MEDICAL, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	103T00000X	Psychologist	212042	NY

General Provider Information

NPI Number	:	1083883458
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXODUSHEALTH MEDICAL, PC

Provider Business Mailing Address
First Line	:	420 E MAIN ST
Second Line	:
City	:	MIDDLETOWN
State	:	NY
Zip	:	10940-2516
Country	:	US
Telephone Number	:	845-294-2595
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 STATE ROUTE 208
Second Line	:
City	:	MONROE
State	:	NY
Zip	:	10950-4648
Country	:	US
Telephone Number	:	845-281-5009
Fax Number	:	845-231-6078

Authorized Official
Title or Position	:	ENROLLMENT SUPERVISOR
Name	:	DENISE REIDY-KNIGHT
Credential	:
Telephone Number	:	845-551-9673

Provider Enumeration Date	:	02/29/2008
Last Update Date	:	03/09/2026

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