Basic Information
Provider Information
NPI: 1467477414
EntityType: 2
ReplacementNPI:  
OrganizationName: EXCEL EMERGENCY PHYSICIAN SERVICES OF HUDSON VALLEY, PLLC
LastName:  
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Mailing Information
Address1: 484 TEMPLE HILL RD
Address2: STE.104
City: NEW WINDSOR
State: NY
PostalCode: 125535557
CountryCode: US
TelephoneNumber: 8455653700
FaxNumber: 8455653696
Practice Location
Address1: 12 N 7TH AVE
Address2:  
City: MOUNT VERNON
State: NY
PostalCode: 105502026
CountryCode: US
TelephoneNumber: 8455653700
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/12/2006
LastUpdateDate: 03/02/2015
NPIDeactivationReasonCode:  
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AuthorizedOfficialLastName: RUVO
AuthorizedOfficialFirstName: ANTHONY
AuthorizedOfficialMiddleName: R
AuthorizedOfficialTitleorPosition: AUTHORIZED MANAGER
AuthorizedOfficialTelephone: 8455653700
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: DR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: MD
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000X  Y193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansEmergency Medicine 

No ID Information.


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