Provider Demographics
NPI: | 1508073537 |
---|---|
Name: | HUDSON VALLEY PODIATRY OBS PC |
Entity Type: | Organization |
Organization Name: | HUDSON VALLEY PODIATRY OBS PC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | CHRISTOS |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | KYROU |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 845-279-2367 |
Mailing Address - Street 1: | 54 NORTH PLANK ROAD |
Mailing Address - Street 2: | |
Mailing Address - City: | NEWBURGH |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 12550 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 845-561-7646 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 54 N PLANK RD |
Practice Address - Street 2: | |
Practice Address - City: | NEWBURGH |
Practice Address - State: | NY |
Practice Address - Zip Code: | 12550-2116 |
Practice Address - Country: | US |
Practice Address - Phone: | 845-561-7646 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-05-17 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NY | 213EG0000X | 213ES0131X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 213ES0131X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot Surgery | Group - Single Specialty |