Basic Information
Provider Information
NPI: 1194842526
EntityType: 2
ReplacementNPI:  
OrganizationName: HUDSON VALLEY PHYSICAL MEDICINE &REHABILITATION,PLLC
LastName:  
FirstName:  
MiddleName:  
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Credential:  
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Mailing Information
Address1: 24 SAW MILL RIVER RD
Address2: SUITE 204
City: HAWTHORNE
State: NY
PostalCode: 105321541
CountryCode: US
TelephoneNumber: 9145929600
FaxNumber: 9146310943
Practice Location
Address1: 24 SAW MILL RIVER RD
Address2: SUITE 204
City: HAWTHORNE
State: NY
PostalCode: 105321541
CountryCode: US
TelephoneNumber: 9145929600
FaxNumber: 9146310943
Other Information
ProviderEnumerationDate: 03/22/2007
LastUpdateDate: 08/22/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: ANNICHIARICO
AuthorizedOfficialFirstName: JOSEPH
AuthorizedOfficialMiddleName: N
AuthorizedOfficialTitleorPosition: PRESIDENT
AuthorizedOfficialTelephone: 9145929600
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: DR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: DO
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208100000X192626NYY193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation 

ID Information
IDTypeStateIssuerDescription
WS97001NYOXFORD ID NUMBEROTHER
108969601NYUNITED HEALTH ID NUMBEROTHER
72Z98101NYBC-BS ID NUMBEROTHER


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