Provider Demographics
NPI:1720846439
Name:MEDICAL ASSOCIATES OF THE HUDSON VALLEY
Entity type:Organization
Organization Name:MEDICAL ASSOCIATES OF THE HUDSON VALLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:M
Authorized Official - Last Name:TACK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:845-338-7140
Mailing Address - Street 1:360 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-3702
Mailing Address - Country:US
Mailing Address - Phone:845-338-7140
Mailing Address - Fax:845-338-7141
Practice Address - Street 1:9 MT AVA MARIA DR
Practice Address - Street 2:
Practice Address - City:PHOENICIA
Practice Address - State:NY
Practice Address - Zip Code:12464
Practice Address - Country:US
Practice Address - Phone:845-338-7140
Practice Address - Fax:845-338-7141
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDICAL ASSOCIATES OF THE HUDSON VALLEY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty