Provider Demographics
NPI:1609821354
Name:MILLENDORF, JEROLD BARRY (MD)
Entity Type:Individual
Prefix:DR
First Name:JEROLD
Middle Name:BARRY
Last Name:MILLENDORF
Suffix:
Gender:M
Credentials:MD
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 350
Mailing Address - Street 2:HUDSON VALLEY EMERGENCY MEDICINE PLLC
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12602
Mailing Address - Country:US
Mailing Address - Phone:610-668-6471
Mailing Address - Fax:610-617-6280
Practice Address - Street 1:1530 ROUTE 9
Practice Address - Street 2:
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-4131
Practice Address - Country:US
Practice Address - Phone:845-297-2511
Practice Address - Fax:845-297-4993
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY138710207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01322870Medicaid
NY97A211Medicare ID - Type Unspecified
A65133Medicare UPIN