Provider Demographics
NPI:1669964706
Name:HURLEY AVENUE FAMILY MEDICINE
Entity type:Organization
Organization Name:HURLEY AVENUE FAMILY MEDICINE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MD/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHIAS
Authorized Official - Middle Name:
Authorized Official - Last Name:VONREUSNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-338-2541
Mailing Address - Street 1:10 GAGNON DR.
Mailing Address - Street 2:
Mailing Address - City:STONE RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:12484
Mailing Address - Country:US
Mailing Address - Phone:845-687-7455
Mailing Address - Fax:845-687-4685
Practice Address - Street 1:10 GAGNON DR.
Practice Address - Street 2:
Practice Address - City:STONE RIDGE
Practice Address - State:NY
Practice Address - Zip Code:12484
Practice Address - Country:US
Practice Address - Phone:845-687-7455
Practice Address - Fax:845-687-4685
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HURLEY AVENUE FAMILY MEDICINE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-05
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty