Provider Demographics
NPI:1538483987
Name:HUDSON VALLEY INTERVENTIONAL MEDICINE, PLLC
Entity Type:Organization
Organization Name:HUDSON VALLEY INTERVENTIONAL MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTING PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:L
Authorized Official - Last Name:RACANELLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-220-2222
Mailing Address - Street 1:575 HUDSON VALLEY AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-4747
Mailing Address - Country:US
Mailing Address - Phone:845-220-2222
Mailing Address - Fax:845-220-2241
Practice Address - Street 1:575 HUDSON VALLEY AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553-4747
Practice Address - Country:US
Practice Address - Phone:845-220-2222
Practice Address - Fax:845-220-2241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6057241261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology