Provider Demographics
NPI:1104049725
Name:MID HUDSON PHYSICAL MEDICINE & REHABILITATION PC
Entity type:Organization
Organization Name:MID HUDSON PHYSICAL MEDICINE & REHABILITATION PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUNITHA
Authorized Official - Middle Name:
Authorized Official - Last Name:POLEPALLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-565-5943
Mailing Address - Street 1:21 N PLANK RD
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-2128
Mailing Address - Country:US
Mailing Address - Phone:845-565-5943
Mailing Address - Fax:
Practice Address - Street 1:21 N PLANK RD
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-2128
Practice Address - Country:US
Practice Address - Phone:845-565-5943
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY19889963174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty