Provider Demographics
NPI:1720215718
Name:VAILS MEDICAL PLLC.
Entity Type:Organization
Organization Name:VAILS MEDICAL PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHINYERE
Authorized Official - Middle Name:E
Authorized Official - Last Name:OFONAGORO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-561-8500
Mailing Address - Street 1:537 BLOOMING GROVE TPKE
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-7843
Mailing Address - Country:US
Mailing Address - Phone:845-561-8500
Mailing Address - Fax:845-561-8855
Practice Address - Street 1:537 BLOOMING GROVE TPKE
Practice Address - Street 2:
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553-7843
Practice Address - Country:US
Practice Address - Phone:845-561-8500
Practice Address - Fax:845-561-8855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-17
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207719207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01922123Medicaid
NYG88195Medicare UPIN
NY01922123Medicaid