NPIMap

Organization Active NPI

Hudson Valley Mall Dental LLP

  • Dentist
  • Kingston, NY
National Provider Identifier
1447550033
Registry record updated Oct 28, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
046043 Issued in NY
Legal business name
HUDSON VALLEY MALL DENTAL LLP
Practice address
1300 Ulster Ave
160
Kingston, NY 12401-1501
Phone
(845) 336-0400
NPI assigned
Oct 28, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2010

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

Authorized official

Name
Ross Krasnov, DDS
Title
Owner
Phone
(845) 336-0400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 046043 NY Primary

Addresses

Primary practice location

1300 Ulster Ave
160
Kingston, NY 12401-1501

Mailing address

1300 Ulster Ave
160
Kingston, NY 12401
Phone (845) 336-0400

Other identifiers 1

IdentifierTypeStateIssuer
01580001MedicaidNY

National Provider Directory

National Provider Directory

Locations

1300 Ulster Ave
Ste 160
Kingston, NY 12401
Phone (845) 336-0400

NPI Registry JSON

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

{
    "created_epoch": "1288224000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1288224000000",
    "number": "1447550033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 ULSTER AVE",
            "address_2": "160",
            "city": "KINGSTON",
            "state": "NY",
            "postal_code": "12401",
            "telephone_number": "845-336-0400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 ULSTER AVE",
            "address_2": "160",
            "city": "KINGSTON",
            "state": "NY",
            "postal_code": "124011501",
            "telephone_number": "845-336-0400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HUDSON VALLEY MALL DENTAL LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-28",
        "last_updated": "2010-10-28",
        "status": "A",
        "authorized_official_last_name": "KRASNOV",
        "authorized_official_first_name": "ROSS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "845-336-0400",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "NY",
            "license": "046043",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01580001",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kingston, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2010; 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.