Provider Demographics
NPI:1558753491
Name:PREMIER MEDICAL ASSOCIATES OF THE HUDSON VALLEY
Entity Type:Organization
Organization Name:PREMIER MEDICAL ASSOCIATES OF THE HUDSON VALLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:JATIVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-526-2080
Mailing Address - Street 1:11 PEEKSKILL HOLLOW RD
Mailing Address - Street 2:112
Mailing Address - City:PUTNAM VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10579-3200
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11 PEEKSKILL HOLLOW RD
Practice Address - Street 2:112
Practice Address - City:PUTNAM VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10579-3200
Practice Address - Country:US
Practice Address - Phone:845-526-2080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHERN WESTCHESTER SURGICAL ASSOCIATES, LLP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-02
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty