| Crystal Run Medical Services Pc | |
|
236 Crystal Run Rd Suite 2 Middletown NY 10941-4009 | |
| (845) 692-3100 | |
| (845) 692-2402 |
| Full Name | Crystal Run Medical Services Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 236 Crystal Run Rd, Middletown, New York |
| Authorized Official Name and Position | Raymond S Basri (OWNER) |
| Authorized Official Contact | 8456923100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Crystal Run Medical Services Pc 236 Crystal Run Rd Suite 2 Middletown NY 10941-4009 Ph: (845) 692-3100 | Crystal Run Medical Services Pc 236 Crystal Run Rd Suite 2 Middletown NY 10941-4009 Ph: (845) 692-3100 |
| NPI Number | 1104921139 |
|---|---|
| Provider Enumeration Date | 09/14/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 5395781249 |
|---|---|
| Medicare Enrollment ID | O20050630001104 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104921139 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | John Podeszwa |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1841291697 PECOS PAC ID: 7618940859 Enrollment ID: I20040825001703 |
| Provider Name | Raymond S Basri |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1659350163 PECOS PAC ID: 3577530260 Enrollment ID: I20040913000859 |
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