Provider Demographics
NPI:1659666840
Name:HUDSON VISTA MEDICAL,PC
Entity Type:Organization
Organization Name:HUDSON VISTA MEDICAL,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-568-2881
Mailing Address - Street 1:70 DUBOIS STREET
Mailing Address - Street 2:5TH FLOOR ADMINISTRATION
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550
Mailing Address - Country:US
Mailing Address - Phone:845-458-4855
Mailing Address - Fax:845-458-4853
Practice Address - Street 1:1510 ROUTE 9W
Practice Address - Street 2:SUITE 102
Practice Address - City:MARLBORO
Practice Address - State:NY
Practice Address - Zip Code:12542-5425
Practice Address - Country:US
Practice Address - Phone:845-795-5500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-15
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207R00000X, 208600000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03377979Medicaid
NY03377979Medicaid