Provider Demographics
NPI:1578577417
Name:MOHAWK VALLEY ORTHOPEDICS, P.C.
Entity Type:Organization
Organization Name:MOHAWK VALLEY ORTHOPEDICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:NA
Authorized Official - Last Name:CECIL, M.D.
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-842-2663
Mailing Address - Street 1:5010 STATE HIGHWAY 30 STE 205
Mailing Address - Street 2:
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-7532
Mailing Address - Country:US
Mailing Address - Phone:518-842-2663
Mailing Address - Fax:518-842-4861
Practice Address - Street 1:5010 STATE HIGHWAY 30 STE 205
Practice Address - Street 2:
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-7532
Practice Address - Country:US
Practice Address - Phone:518-842-2663
Practice Address - Fax:518-842-4861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2023-07-06
Deactivation Date:2023-06-06
Deactivation Code:
Reactivation Date:2023-07-06
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1578577417OtherMEDICARE RAILROAD
NY02049750Medicaid
NY1578577417OtherMEDICARE RAILROAD
NY02049750Medicaid
NY54654AMedicare PIN