Provider Demographics
NPI:1184659906
Name:KORNREICH, DOUGLAS (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:KORNREICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 550
Mailing Address - Street 2:2 CATHARINE ST
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12602
Mailing Address - Country:US
Mailing Address - Phone:845-790-2614
Mailing Address - Fax:845-790-2613
Practice Address - Street 1:1980 CROMPOND RD
Practice Address - Street 2:HUDSON VALLEY HOSPITAL CNTR
Practice Address - City:CORTLANDT MANOR
Practice Address - State:NY
Practice Address - Zip Code:10567
Practice Address - Country:US
Practice Address - Phone:914-737-9000
Practice Address - Fax:845-790-2613
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY220850207L00000X
NY220850-1207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02425592Medicaid
P00197943OtherRAILROAD MEDICARE
NY9K0241Medicare PIN
NYDK09K02410Medicare PIN
P00197943OtherRAILROAD MEDICARE