| Rondout Valley Family Med Pc | |
|
10 Gagnon Dr Stone Ridge NY 12484-5120 | |
| (845) 687-9933 | |
| (845) 687-9953 |
| Full Name | Rondout Valley Family Med Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 10 Gagnon Dr, Stone Ridge, New York |
| Authorized Official Name and Position | Peter James Petrulis (PRESIDENT) |
| Authorized Official Contact | 8456879933 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Rondout Valley Family Med Pc Po Box 547 Stone Ridge NY 12484-0547 Ph: (845) 687-9933 | Rondout Valley Family Med Pc 10 Gagnon Dr Stone Ridge NY 12484-5120 Ph: (845) 687-9933 |
| NPI Number | 1679514004 |
|---|---|
| Provider Enumeration Date | 06/09/2006 |
| Last Update Date | 10/09/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679514004 | NPI | - | NPPES |
| 10031715 | Other | NY | CDPHN |
| 87726 | Other | NY | UNITED HEALTHCARE INS CO |
| 00950523 | Medicaid | NY | |
| 3292 | Other | NY | GHI HMO SELECT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 160527 (New York) | Primary |
| 363A00000X | Physician Assistant | 008467-1 (New York) | Secondary |
St. Peters Health Partners Medical Associates Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 10 Gagnon Dr, Stone Ridge, NY 12484 Phone: 548-687-7455 | |
Stone Ridge Family Practice Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 10 Gagnon Dr., Stone Ridge, NY 12484 Phone: 845-687-7455 Fax: 845-687-4685 |