MEDICARE: MEDICAL ASSOCIATES OF THE HUDSON VALLEY

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1336906304
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL ASSOCIATES OF THE HUDSON VALLEY

Provider Business Mailing Address
First Line	:	360 WASHINGTON AVE
Second Line	:
City	:	KINGSTON
State	:	NY
Zip	:	12401-3702
Country	:	US
Telephone Number	:	845-338-7140
Fax Number	:	845-338-7141

Provider Business Practice Location Address
First Line	:	9 ELWYN LN
Second Line	:
City	:	WOODSTOCK
State	:	NY
Zip	:	12498-1301
Country	:	US
Telephone Number	:	845-338-7140
Fax Number	:	845-338-7141

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	MARC TACK
Credential	:	DO
Telephone Number	:	845-338-7140

Provider Enumeration Date	:	03/05/2024
Last Update Date	:	03/05/2024

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