Provider Demographics
NPI:1942334719
Name:MID VALLEY COMPREHENSIVE OBGYN, PC
Entity Type:Organization
Organization Name:MID VALLEY COMPREHENSIVE OBGYN, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:P
Authorized Official - Last Name:CROSBY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:877-844-3311
Mailing Address - Street 1:PO BOX 8084
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12402-8084
Mailing Address - Country:US
Mailing Address - Phone:877-844-3311
Mailing Address - Fax:845-247-0822
Practice Address - Street 1:28 N FRONT ST
Practice Address - Street 2:
Practice Address - City:NEW PALTZ
Practice Address - State:NY
Practice Address - Zip Code:12561-1410
Practice Address - Country:US
Practice Address - Phone:877-844-3311
Practice Address - Fax:845-247-0822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY196507207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1770548174OtherNPI
NY01723904Medicaid
NY01723904Medicaid
NY1770548174OtherNPI