NPIMap

Organization Active NPI

Timber Ridge Medical Assoc, P.C.

  • Pulmonary Disease Physician
  • Middletown, NY
National Provider Identifier
1073647673
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
Legal business name
TIMBER RIDGE MEDICAL ASSOC, P.C.
Practice address
90 Crystal Run Rd
403
Middletown, NY 10941-7101
Phone
(845) 703-8806
Fax
(845) 703-9058
NPI assigned
Mar 15, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Eileen Petrilak
Title
Practice Manager
Phone
(845) 703-8806

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RP1001X Primary

Addresses

Primary practice location

90 Crystal Run Rd
403
Middletown, NY 10941-7101

Mailing address

90 Crystal Run Rd
403
Middletown, NY 10941-7101
Phone (845) 703-8806

National Provider Directory

National Provider Directory

Locations

90 Crystal Run Rd
Ste 403
Middletown, NY 10941
Phone (845) 703-8806

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1073647673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "90 CRYSTAL RUN RD",
            "address_2": "403",
            "city": "MIDDLETOWN",
            "state": "NY",
            "postal_code": "109417101",
            "telephone_number": "845-703-8806",
            "fax_number": "845-703-9058"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 CRYSTAL RUN RD",
            "address_2": "403",
            "city": "MIDDLETOWN",
            "state": "NY",
            "postal_code": "109417101",
            "telephone_number": "845-703-8806",
            "fax_number": "845-703-9058"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIMBER RIDGE MEDICAL ASSOC, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-15",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PETRILAK",
        "authorized_official_first_name": "EILEEN",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "845-703-8806"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Middletown, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.