Basic Information
Provider Information | |||||||||
NPI: | 1154343614 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | FOY | ||||||||
FirstName: | BRIDGET | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | DO | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | FOY | ||||||||
OtherFirstName: | BRIDGET | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | DO | ||||||||
OtherLastNameType: | 2 | ||||||||
Mailing Information | |||||||||
Address1: | 279 MAIN ST | ||||||||
Address2: | SUITE 102 | ||||||||
City: | NEW PALTZ | ||||||||
State: | NY | ||||||||
PostalCode: | 125611623 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8452552930 | ||||||||
FaxNumber: | 8452553089 | ||||||||
Practice Location | |||||||||
Address1: | 279 MAIN ST | ||||||||
Address2: | SUITE 102 | ||||||||
City: | NEW PALTZ | ||||||||
State: | NY | ||||||||
PostalCode: | 125611623 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8452552930 | ||||||||
FaxNumber: | 8452553089 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/24/2006 | ||||||||
LastUpdateDate: | 07/21/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 233478-1 | NY | Y |   | Allopathic & Osteopathic Physicians | Family Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 233478-1 | 01 | NY | 050 | OTHER |