Provider Demographics
NPI:1073712477
Name:LIDIA POUSADA, MD, P.C.
Entity Type:Organization
Organization Name:LIDIA POUSADA, MD, P.C.
Other - Org Name:HUDSON VALLEY GERIATRICS & INTERNAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS/OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NIEVES
Authorized Official - Middle Name:
Authorized Official - Last Name:POUSADA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-769-2900
Mailing Address - Street 1:141 N STATE RD
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:BRIARCLIFF MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10510-1459
Mailing Address - Country:US
Mailing Address - Phone:914-762-2900
Mailing Address - Fax:914-762-8500
Practice Address - Street 1:141 N STATE RD
Practice Address - Street 2:1ST FLOOR
Practice Address - City:BRIARCLIFF MANOR
Practice Address - State:NY
Practice Address - Zip Code:10510-1459
Practice Address - Country:US
Practice Address - Phone:914-762-2900
Practice Address - Fax:914-762-8500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDE1273OtherRAILROAD MEDICARE PIN
NYWCW571Medicare PIN