Provider Demographics
NPI:1033133632
Name:NEWBURGH INTERNAL MEDICINE,P.C.
Entity Type:Organization
Organization Name:NEWBURGH INTERNAL MEDICINE,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-561-1575
Mailing Address - Street 1:308 FULLERTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-3722
Mailing Address - Country:US
Mailing Address - Phone:845-561-1575
Mailing Address - Fax:845-561-1796
Practice Address - Street 1:308 FULLERTON AVE
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-3722
Practice Address - Country:US
Practice Address - Phone:845-561-1575
Practice Address - Fax:845-561-1796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY138024174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00510563Medicaid
NY01034073Medicaid
NYC08031Medicare UPIN
NY00510563Medicaid
NY97D741Medicare ID - Type UnspecifiedEDWIN A .COWEN,M.D.
NY01034073Medicaid