Basic Information
| Provider Information | |||||||||
| NPI: | 1215665203 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EYW MEDICAL PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 723 COUNTY ROUTE 27 | ||||||||
| Address2: | |||||||||
| City: | ANCRAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125025071 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6462489946 | ||||||||
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| Practice Location | |||||||||
| Address1: | 71 PROSPECT AVE | ||||||||
| Address2: | |||||||||
| City: | HUDSON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125342907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5188282565 | ||||||||
| FaxNumber: | 5188284055 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2022 | ||||||||
| LastUpdateDate: | 08/09/2022 | ||||||||
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| AuthorizedOfficialLastName: | WANG | ||||||||
| AuthorizedOfficialFirstName: | ELLEN | ||||||||
| AuthorizedOfficialMiddleName: | Y | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6462489946 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 08/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.