Provider Demographics
NPI:1710112529
Name:RIVER VALLEY ENDOCRINOLOGY, PC
Entity Type:Organization
Organization Name:RIVER VALLEY ENDOCRINOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:SOFIA
Authorized Official - Last Name:KAMINSKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-561-7902
Mailing Address - Street 1:815 BLOOMING GROVE TPKE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-8135
Mailing Address - Country:US
Mailing Address - Phone:845-561-7902
Mailing Address - Fax:845-561-0025
Practice Address - Street 1:815 BLOOMING GROVE TPKE
Practice Address - Street 2:SUITE 400
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553-8135
Practice Address - Country:US
Practice Address - Phone:845-561-7902
Practice Address - Fax:845-561-0025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-22
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY187767207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01278591Medicaid