Provider Demographics
NPI:1831241009
Name:RIVER VALLEY FAMILY MEDICAL SERVICES P.C.
Entity type:Organization
Organization Name:RIVER VALLEY FAMILY MEDICAL SERVICES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:DABOUL
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:845-557-6411
Mailing Address - Street 1:3452 STATE ROUTE 97
Mailing Address - Street 2:
Mailing Address - City:BARRYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12719-5923
Mailing Address - Country:US
Mailing Address - Phone:845-557-6411
Mailing Address - Fax:845-557-8005
Practice Address - Street 1:3452 STATE ROUTE 97
Practice Address - Street 2:
Practice Address - City:BARRYVILLE
Practice Address - State:NY
Practice Address - Zip Code:12719-5923
Practice Address - Country:US
Practice Address - Phone:845-557-6411
Practice Address - Fax:845-557-8005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY165904207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDN7705OtherRAILROAD MEDICARE
NYDN7705OtherRAILROAD MEDICARE
NYA100000018Medicare PIN