Provider Demographics
NPI:1043246077
Name:DUTCHESS AMBULATORY SURGICAL CENTER
Entity Type:Organization
Organization Name:DUTCHESS AMBULATORY SURGICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLOSKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-473-6144
Mailing Address - Street 1:325 FOUNDERS WAY
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-2516
Mailing Address - Country:US
Mailing Address - Phone:845-473-6144
Mailing Address - Fax:845-473-5601
Practice Address - Street 1:325 FOUNDERS WAY
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-2516
Practice Address - Country:US
Practice Address - Phone:845-473-6144
Practice Address - Fax:845-473-5601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1302208R261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
10035585OtherCDPHP
NY317513OtherMVP
A1314785OtherOXFORD
003631OtherEMPIRE BCBS
NY01902698Medicaid
IC7999OtherHEALTHNET
2042937OtherAETNA
10035585OtherCDPHP