Provider Demographics
NPI:1053332270
Name:PHYSICIAN NETWORK, PC
Entity Type:Organization
Organization Name:PHYSICIAN NETWORK, PC
Other - Org Name:LONG TERM CARE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SHAREHOLDER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:Z
Authorized Official - Last Name:ARONZON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-483-6217
Mailing Address - Street 1:PO BOX 1151
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12602-1151
Mailing Address - Country:US
Mailing Address - Phone:845-483-6217
Mailing Address - Fax:845-483-6108
Practice Address - Street 1:45 READE PL
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-3947
Practice Address - Country:US
Practice Address - Phone:845-483-6217
Practice Address - Fax:845-483-6108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01418991Medicaid
NYW24191Medicare ID - Type Unspecified