Provider Demographics
NPI:1477673739
Name:HUDSON VALLEY OTOLARYNGOLOGY
Entity Type:Organization
Organization Name:HUDSON VALLEY OTOLARYNGOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-471-4086
Mailing Address - Street 1:45 READE PL
Mailing Address - Street 2:DYSON CENTER 3RD FLOOR
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-3947
Mailing Address - Country:US
Mailing Address - Phone:845-471-4086
Mailing Address - Fax:
Practice Address - Street 1:45 READE PL
Practice Address - Street 2:DYSON CENTER 3RD FLOOR
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-3947
Practice Address - Country:US
Practice Address - Phone:845-471-4086
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00874337Medicaid
NY02183957Medicaid
NY00874337Medicaid
NY24D24BW391Medicare ID - Type Unspecified
NYH30962Medicare UPIN
NY4M246BW391Medicare ID - Type Unspecified