Basic Information
| Provider Information | |||||||||
| NPI: | 1417943861 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HUDSON VALLEY DERMATOLOGY, P. C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 GIDNEY AVE | ||||||||
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| City: | NEWBURGH | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125503701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8455611565 | ||||||||
| FaxNumber: | 8455611578 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 GIDNEY AVE | ||||||||
| Address2: | |||||||||
| City: | NEWBURGH | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125503701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8455611565 | ||||||||
| FaxNumber: | 8455611578 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2005 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | GREENBLATT | ||||||||
| AuthorizedOfficialFirstName: | HENRY | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8455611565 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M. D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.