Provider Demographics
NPI:1306184908
Name:HURLEY AVENUE FAMILY MEDICINE
Entity Type:Organization
Organization Name:HURLEY AVENUE FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-340-1185
Mailing Address - Street 1:211 HURLEY AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-2400
Mailing Address - Country:US
Mailing Address - Phone:845-339-2804
Mailing Address - Fax:845-338-5982
Practice Address - Street 1:211 HURLEY AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-2400
Practice Address - Country:US
Practice Address - Phone:845-339-2804
Practice Address - Fax:845-338-5982
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HURLEY AVENUE FAMILY MEDCINE, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY129228207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWEJ861Medicare PIN