Provider Demographics
NPI:1851369060
Name:BOLTIN, HARRY N (MD)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:N
Last Name:BOLTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 HARBOR CV
Mailing Address - Street 2:
Mailing Address - City:PIERMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10968-1087
Mailing Address - Country:US
Mailing Address - Phone:845-565-1989
Mailing Address - Fax:845-863-0072
Practice Address - Street 1:320 ROBINSON AVE
Practice Address - Street 2:C/O ORANGE RADIOLOGY ASSOCIATES, P.C.
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-3353
Practice Address - Country:US
Practice Address - Phone:845-565-1989
Practice Address - Fax:845-863-0072
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0927312085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00149904Medicaid
NY00149904Medicaid
NYB15859Medicare UPIN