Provider Demographics
NPI:1700979507
Name:POUGHKEEPSIE MEDICAL GROUP LLP
Entity Type:Organization
Organization Name:POUGHKEEPSIE MEDICAL GROUP LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISIOR
Authorized Official - Prefix:
Authorized Official - First Name:SUMITA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZUMDAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-454-5000
Mailing Address - Street 1:375 HOOKER AVE
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603
Mailing Address - Country:US
Mailing Address - Phone:845-454-5000
Mailing Address - Fax:845-454-9880
Practice Address - Street 1:375 HOOKER AVE.
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603
Practice Address - Country:US
Practice Address - Phone:845-454-5000
Practice Address - Fax:845-454-9880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01076948Medicaid
NY01076948Medicaid