Provider Demographics
NPI:1093092603
Name:ADVANCED PODIATRY ASSOCIATES OF THE HUDSON VALLEY LLP
Entity Type:Organization
Organization Name:ADVANCED PODIATRY ASSOCIATES OF THE HUDSON VALLEY LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIPPO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:845-561-7646
Mailing Address - Street 1:54 N PLANK RD
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-2116
Mailing Address - Country:US
Mailing Address - Phone:845-561-7646
Mailing Address - Fax:845-561-3218
Practice Address - Street 1:54 N PLANK RD
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-2116
Practice Address - Country:US
Practice Address - Phone:845-561-7646
Practice Address - Fax:845-561-3218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-10
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100060974Medicare PIN