Provider Demographics
NPI:1104825793
Name:HUDSON VALLEY ONCOLOGY ASSOCIATES PLLC
Entity Type:Organization
Organization Name:HUDSON VALLEY ONCOLOGY ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:D
Authorized Official - Last Name:KOUTCHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-485-7767
Mailing Address - Street 1:712 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOOSIC
Mailing Address - State:PA
Mailing Address - Zip Code:18507-1094
Mailing Address - Country:US
Mailing Address - Phone:570-451-3910
Mailing Address - Fax:570-451-3236
Practice Address - Street 1:19 COOKE ST
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-1303
Practice Address - Country:US
Practice Address - Phone:845-485-7767
Practice Address - Fax:845-473-0841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-18
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0062057Medicaid
NY02591468Medicaid
NJ0062057Medicaid
NYW6T971Medicare PIN