Provider Demographics
NPI:1083837595
Name:HUDSON VALLEY EMERGENCY PHYSICIAN SERVICES, PC
Entity Type:Organization
Organization Name:HUDSON VALLEY EMERGENCY PHYSICIAN SERVICES, PC
Other - Org Name:TRI-STATE EMERGENCY PHYSICIANS, PLLC
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:CAVANAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:703-973-2320
Mailing Address - Street 1:1005 ALICE DR
Mailing Address - Street 2:APT 111
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-2445
Mailing Address - Country:US
Mailing Address - Phone:703-973-2320
Mailing Address - Fax:
Practice Address - Street 1:484 TEMPLE HILL RD
Practice Address - Street 2:SUITE 102
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553-5557
Practice Address - Country:US
Practice Address - Phone:803-774-9115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011833282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital