Provider Demographics
NPI:1265432736
Name:VENTRUDO, STEVEN L (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:L
Last Name:VENTRUDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:155 CRYSTAL RUN RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10941-4028
Mailing Address - Country:US
Mailing Address - Phone:845-703-6999
Mailing Address - Fax:845-703-6297
Practice Address - Street 1:97 ROUTE 303
Practice Address - Street 2:
Practice Address - City:TAPPAN
Practice Address - State:NY
Practice Address - Zip Code:10983-2514
Practice Address - Country:US
Practice Address - Phone:845-359-5005
Practice Address - Fax:845-359-7890
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2015-04-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY166157-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01026824Medicaid
NY01026824Medicaid
NY84D121Medicare PIN