Provider Demographics
NPI:1811064520
Name:ERIVER NEUROLOGY OF NEW YORK. LLC
Entity type:Organization
Organization Name:ERIVER NEUROLOGY OF NEW YORK. LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-452-9750
Mailing Address - Street 1:200 WESTAGE BUSINESS CTR DR STE 324
Mailing Address - Street 2:
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-2265
Mailing Address - Country:US
Mailing Address - Phone:845-452-9750
Mailing Address - Fax:845-452-9751
Practice Address - Street 1:200 WESTAGE BUSINESS CTR DR STE 324
Practice Address - Street 2:
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-2265
Practice Address - Country:US
Practice Address - Phone:845-452-9750
Practice Address - Fax:845-452-9751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02724909Medicaid
NYWBW721Medicare PIN
NY70H481Medicare ID - Type UnspecifiedSAMUEL KOSZER MD
NY1982697975OtherNPI SAMUEL KOSZER MD
NYF58443Medicare UPIN
NYWBW721Medicare ID - Type UnspecifiedERIVER GROUP NUMBER
NYG94466Medicare UPIN
NY618N3-1Medicare ID - Type UnspecifiedGLENN CASTANEDA MD
NY01527595Medicaid
NY01821058Medicaid