Provider Demographics
NPI:1184703308
Name:HUDSON VALLEY HEALTH SPECIALTIES, INC
Entity type:Organization
Organization Name:HUDSON VALLEY HEALTH SPECIALTIES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-331-4300
Mailing Address - Street 1:139 CORNELL ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-3633
Mailing Address - Country:US
Mailing Address - Phone:845-338-1234
Mailing Address - Fax:845-338-6284
Practice Address - Street 1:139 CORNELL ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-3633
Practice Address - Country:US
Practice Address - Phone:845-338-1234
Practice Address - Fax:845-338-6284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5501208R261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02087832Medicaid
NYW3Z521Medicare ID - Type UnspecifiedMEDICARE GROUP ID