Provider Demographics
NPI:1609160407
Name:CATSKILL MOBILE MEDICAL CLINIC
Entity Type:Organization
Organization Name:CATSKILL MOBILE MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:CHAYA
Authorized Official - Middle Name:R
Authorized Official - Last Name:LEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:845-428-1700
Mailing Address - Street 1:PO BOX 113
Mailing Address - Street 2:330 LAUREL AVE
Mailing Address - City:FALLSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:12733
Mailing Address - Country:US
Mailing Address - Phone:845-428-1700
Mailing Address - Fax:877-647-4509
Practice Address - Street 1:330 LAUREL AVE
Practice Address - Street 2:
Practice Address - City:FALLSBURG
Practice Address - State:NY
Practice Address - Zip Code:12733
Practice Address - Country:US
Practice Address - Phone:845-428-1700
Practice Address - Fax:877-647-4509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY336123363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty