Rondout Valley Family Med PC
Organization Active NPI Family Medicine Physician · Stone Ridge, NY
NPI 1679514004 · NPPES record last updated Oct 9, 2007
Key facts
- NPI
- 1679514004
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 160527 (NY)
- Legal business name
- RONDOUT VALLEY FAMILY MED PC
- Practice address
- 10 Gagnon Dr
Stone Ridge, NY 12484-5120 - Phone
- (845) 687-9933
- Fax
- (845) 687-9953
- NPI assigned
- Jun 9, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. Peter James Petrulis, D.O.
- Title
- President
- Phone
- (845) 687-9933
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | 160527 | NY | Yes |
| Physician Assistant |
363A00000X | 008467-1 | NY |
Addresses
Primary practice location
10 Gagnon Dr
Stone Ridge, NY 12484-5120
Mailing address
PO Box 547
Stone Ridge, NY 12484-0547
Phone (845) 687-9933
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 10031715 | Other | NY | CDPHN |
| 87726 | Other | NY | UNITED HEALTHCARE INS CO |
| 00950523 | Medicaid | NY | |
| 3292 | Other | NY | GHI HMO SELECT |
Other providers in Stone Ridge, NY
- Phillip E. Parker, D.D.S., PC
- Kevin Paul Placentino
- Priscilla Alden Reynolds
- Tiffany Robinson
- Rondout Valley Family Dentistry
- Ari Rosen
- Renee Gabrielle Sabin-Haggerty
- Robin Dale Saltzman
- Sarah Gugluizza LCSW, PLLC Dba Rising Lotus Counseling
- Ellen Lydia Sebald
All providers in Stone Ridge, NY · Family Medicine Physician in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 9, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.