Hurley Avenue Family Medicine

Organization Active NPI Family Medicine Physician · Stone Ridge, NY

NPI 1669964706 · NPPES record last updated Jun 5, 2018

Key facts

NPI
1669964706
Entity type
Organization (NPI type 2)
Primary specialty
Family Medicine Physician 207Q00000X
Legal business name
HURLEY AVENUE FAMILY MEDICINE
Practice address
10 Gagnon Dr.
Stone Ridge, NY 12484
Phone
(845) 687-7455
Fax
(845) 687-4685
NPI assigned
Jun 5, 2018
Organization subpart
Yes
Parent organization (as reported)
HURLEY AVENUE FAMILY MEDICINE

Authorized official

Name
Matthias Vonreusner, MD
Title
MD/Partner
Phone
(845) 338-2541

Corporate family (same tax ID) 3

Organizations that report the same tax identification number in the National Provider Directory.

National Provider Directory

Tax ID family
Hurley Ave Family Med PLLC (4 organizations share this tax ID)
Part of
Hurley Ave Family Med PLLC

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician
Group: 193400000X SINGLE SPECIALTY GROUP
207Q00000X Yes

Addresses

Primary practice location

10 Gagnon Dr.
Stone Ridge, NY 12484

Mailing address

10 Gagnon Dr.
Stone Ridge, NY 12484
Phone (845) 687-7455

Other names

  • Stone Ridge Family Practice Other name

Other providers in Stone Ridge, NY

All providers in Stone Ridge, NY · Family Medicine Physician in New York

Sources for this page

Verify at the official NPI Registry.