Provider Demographics
NPI:1679832208
Name:HURLEY AVENUE FAMILY MEDICINE
Entity Type:Organization
Organization Name:HURLEY AVENUE FAMILY MEDICINE
Other - Org Name:CATSKILL FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-340-1185
Mailing Address - Street 1:211 HURLEY AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-2400
Mailing Address - Country:US
Mailing Address - Phone:845-340-1185
Mailing Address - Fax:845-338-5982
Practice Address - Street 1:146 JEFFERSON HTS
Practice Address - Street 2:
Practice Address - City:CATSKILL
Practice Address - State:NY
Practice Address - Zip Code:12414-1215
Practice Address - Country:US
Practice Address - Phone:518-943-6101
Practice Address - Fax:518-943-6922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-16
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY217336207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWEJ863Medicare PIN