Provider Demographics
NPI:1659898054
Name:HURLEY AVENUE MEDICINE COMMUNITY CARE
Entity Type:Organization
Organization Name:HURLEY AVENUE MEDICINE COMMUNITY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHIAS
Authorized Official - Middle Name:
Authorized Official - Last Name:VONREUSNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-339-2804
Mailing Address - Street 1:211 HURLEY AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401
Mailing Address - Country:US
Mailing Address - Phone:845-339-2804
Mailing Address - Fax:845-338-5982
Practice Address - Street 1:211 HURLEY AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401
Practice Address - Country:US
Practice Address - Phone:845-339-2804
Practice Address - Fax:845-338-5982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-25
Last Update Date:2017-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty