Provider Demographics
NPI:1467556696
Name:NEPHROLOGY & HYPERTENSION OF HUDSON VALLEY, PLLC
Entity Type:Organization
Organization Name:NEPHROLOGY & HYPERTENSION OF HUDSON VALLEY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KHOAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:FELDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-561-6191
Mailing Address - Street 1:169 N PLANK RD
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-1723
Mailing Address - Country:US
Mailing Address - Phone:845-561-6191
Mailing Address - Fax:845-561-4145
Practice Address - Street 1:169 N PLANK RD
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550
Practice Address - Country:US
Practice Address - Phone:845-561-6191
Practice Address - Fax:845-561-4145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY143328207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00510114-060Medicaid
35A231Medicare ID - Type Unspecified
C08980Medicare UPIN