Provider Demographics
NPI:1851332027
Name:NORTHERN DUTCHESS ENT PLLC
Entity Type:Organization
Organization Name:NORTHERN DUTCHESS ENT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NADER
Authorized Official - Middle Name:
Authorized Official - Last Name:KAYAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-875-3094
Mailing Address - Street 1:55 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:RHINEBECK
Mailing Address - State:NY
Mailing Address - Zip Code:12572
Mailing Address - Country:US
Mailing Address - Phone:845-876-3094
Mailing Address - Fax:845-876-4217
Practice Address - Street 1:55 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:RHINEBECK
Practice Address - State:NY
Practice Address - Zip Code:12572
Practice Address - Country:US
Practice Address - Phone:845-876-3094
Practice Address - Fax:845-876-4217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY132900207Y00000X
NY220446207Y00000X
NY2265551207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02165020Medicaid
NY00463016Medicaid
NY02731455Medicaid
B11763Medicare UPIN
NY00463016Medicaid
NY6M4131Medicare ID - Type Unspecified
NY26A531Medicare ID - Type Unspecified