Provider Demographics
NPI:1780742072
Name:FESTA, JAMES KEITH (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:KEITH
Last Name:FESTA
Suffix:
Gender:M
Credentials:MD
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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 1:1687 ROUTE 9W
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:NY
Practice Address - Zip Code:12547-5433
Practice Address - Country:US
Practice Address - Phone:845-703-6999
Practice Address - Fax:845-703-6297
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2021-07-06
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Provider Licenses
StateLicense IDTaxonomies
NY175653207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01094935Medicaid
NYA400114188Medicare PIN
A62105Medicare UPIN