Provider Demographics
NPI:1205120482
Name:SOMERS ORTHOPAEDIC SURGERY AND SPORTS MEDICINE GROUP PLLC
Entity type:Organization
Organization Name:SOMERS ORTHOPAEDIC SURGERY AND SPORTS MEDICINE GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:S
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:845-278-4321
Practice Address - Street 1:75 CRYSTAL RUN RD
Practice Address - Street 2:SUITE 135
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10941-7000
Practice Address - Country:US
Practice Address - Phone:845-278-8400
Practice Address - Fax:845-278-4321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-05
Last Update Date:2011-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWCJ511Medicare PIN