Provider Demographics
NPI:1326093972
Name:HUDSON VALLEY THORACIC & VASCULAR ASSOC. PLLC
Entity Type:Organization
Organization Name:HUDSON VALLEY THORACIC & VASCULAR ASSOC. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ELLIS
Authorized Official - Last Name:GINSBURG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-362-0075
Mailing Address - Street 1:70 HATFIELD LN
Mailing Address - Street 2:SUITE 202
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-6734
Mailing Address - Country:US
Mailing Address - Phone:845-291-3656
Mailing Address - Fax:
Practice Address - Street 1:70 HATFIELD LN
Practice Address - Street 2:SUITE 202
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-6734
Practice Address - Country:US
Practice Address - Phone:845-291-3656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1478102086S0129X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02558905Medicaid
NY02558905Medicaid