Provider Demographics
NPI:1659303410
Name:HURST, FRED S (MD)
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:S
Last Name:HURST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:FRED
Other - Middle Name:S
Other - Last Name:HURST
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:200 WESTAGE BUSINESS CTR DR
Mailing Address - Street 2:SUITE 324
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-2264
Mailing Address - Country:US
Mailing Address - Phone:845-896-0611
Mailing Address - Fax:845-896-0616
Practice Address - Street 1:200WESTAGE BUINESS CENTER
Practice Address - Street 2:SUITE324
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524
Practice Address - Country:US
Practice Address - Phone:845-896-0611
Practice Address - Fax:845-896-0616
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY091385207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY133544120OtherTAX ID
NY00535286Medicaid
NY521941Medicare ID - Type Unspecified