Provider Demographics
NPI:1548216831
Name:HUDSON VALLEY HOSPITAL PHYSICIAN PLLC
Entity type:Organization
Organization Name:HUDSON VALLEY HOSPITAL PHYSICIAN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:SPAGNOLI
Authorized Official - Last Name:PINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-342-7615
Mailing Address - Street 1:PO BOX 1013
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-8013
Mailing Address - Country:US
Mailing Address - Phone:845-615-1141
Mailing Address - Fax:845-294-4333
Practice Address - Street 1:60 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-4133
Practice Address - Country:US
Practice Address - Phone:845-342-7615
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02500530Medicaid
NY02500530Medicaid