Provider Demographics
NPI:1174716021
Name:HUDSON VALLEY CLINICAL LABORATORY
Entity type:Organization
Organization Name:HUDSON VALLEY CLINICAL LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAMO
Authorized Official - Middle Name:
Authorized Official - Last Name:BALIGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-455-5700
Mailing Address - Street 1:ONE PINE STREET SUITE 4
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601
Mailing Address - Country:US
Mailing Address - Phone:866-455-5700
Mailing Address - Fax:
Practice Address - Street 1:1 PINE STREET SPUR STE 4
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-3963
Practice Address - Country:US
Practice Address - Phone:866-455-5700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========OtherL85531