Provider Demographics
NPI:1891972709
Name:SOMERS ORTHOPAEDIC SURGERY & SPORTS MED GROUP PLLC
Entity Type:Organization
Organization Name:SOMERS ORTHOPAEDIC SURGERY & SPORTS MED GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCHALTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-278-8400
Mailing Address - Street 1:664 STONELEIGH AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512-3940
Mailing Address - Country:US
Mailing Address - Phone:845-278-8400
Mailing Address - Fax:845-278-4320
Practice Address - Street 1:2 VICTORY CT
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-1745
Practice Address - Country:US
Practice Address - Phone:845-565-1454
Practice Address - Fax:845-565-9803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWCJ511Medicare PIN
NY4682510004Medicare NSC