The Pediatric Specialty Practices of the Greater Hudson Valley

Primary specialty

Pediatric Cardiology PhysicianTaxonomy code 2080P0202X

License

195450-1 Issued in NY

Legal business name

THE PEDIATRIC SPECIALTY PRACTICES OF THE GREATER HUDSON VALLEY

Practice address

75 Crystal Run Rd
Suite 102
Middletown, NY 10941-7000

Phone

(845) 703-7000

Fax

(845) 703-0160

NPI assigned

Feb 1, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Eric D Fethke, M.D.

Title

Director

Phone

(845) 703-7000

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1170288000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1227484800000",
    "number": "1770620163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 CRYSTAL RUN RD",
            "address_2": "SUITE 102",
            "city": "MIDDLETOWN",
            "state": "NY",
            "postal_code": "109417000",
            "telephone_number": "845-703-7000",
            "fax_number": "845-703-0160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 CRYSTAL RUN RD",
            "address_2": "SUITE 102",
            "city": "MIDDLETOWN",
            "state": "NY",
            "postal_code": "109417000",
            "telephone_number": "845-703-7000",
            "fax_number": "845-703-0160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE PEDIATRIC SPECIALTY PRACTICES OF THE GREATER HUDSON VALLEY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-01",
        "last_updated": "2008-11-24",
        "status": "A",
        "authorized_official_last_name": "FETHKE",
        "authorized_official_first_name": "ERIC",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "845-703-7000",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2080P0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "NY",
            "license": "195450-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01488655",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2008; 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.