Basic Information
| Provider Information | |||||||||
| NPI: | 1356374649 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RIVERSIDE MEDICAL PRACTICE, PLLC | ||||||||
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| OtherOrganizationName: | HUDSON CARDIOTHORACIC SURGEONS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1171 | ||||||||
| Address2: | |||||||||
| City: | POUGHKEEPSIE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 126021171 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8454836217 | ||||||||
| FaxNumber: | 8454836108 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 COLUMBIA ST | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | POUGHKEEPSIE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 126013923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8454830100 | ||||||||
| FaxNumber: | 8454830200 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | ARONZON | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
| AuthorizedOfficialMiddleName: | Z | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8454836217 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
ID Information
| ID | Type | State | Issuer | Description | 02632011 | 05 | NY | MEDICAID |