1588745905 NPI number — KELLY S RAMSEY MD

Table of content: KELLY S RAMSEY MD (NPI 1588745905)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588745905 NPI number — KELLY S RAMSEY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAMSEY
Provider First Name:
KELLY
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588745905
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/09/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5036
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHITE PLAINS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10602-5036
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-790-7990
Provider Business Mailing Address Fax Number:
845-790-9036

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 WEBSTER AVE STE 202
Provider Second Line Business Practice Location Address:
HUDSON RIVER HEALTHCARE, INC.
Provider Business Practice Location Address City Name:
POUGHKEEPSIE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12601-1362
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-483-5700
Provider Business Practice Location Address Fax Number:
845-483-5708
Provider Enumeration Date:
10/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  233631 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 02794012 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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