Provider Demographics
NPI:1316110323
Name:E. D. BATTLES, JR., M.D., P.C.
Entity type:Organization
Organization Name:E. D. BATTLES, JR., M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:E
Authorized Official - Middle Name:DELAND
Authorized Official - Last Name:BATTLES
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:845-358-4674
Mailing Address - Street 1:1 SALISBURY PT
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-4735
Mailing Address - Country:US
Mailing Address - Phone:845-358-4674
Mailing Address - Fax:845-358-4869
Practice Address - Street 1:1 SALISBURY PT
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-4735
Practice Address - Country:US
Practice Address - Phone:845-358-4674
Practice Address - Fax:845-358-4869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-10
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY083332261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00272160Medicaid
B12019Medicare UPIN
NY270811Medicare PIN