Individual
BEAU STATES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
70 DUBOIS ST, NEWBURGH, NY 12550
(845) 561-4400
Mailing address
16 CEDAR RIDGE RD, NEW PALTZ, NY 12561-2711
(818) 645-1425
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
703282
NY
367500000X
Certified Registered Nurse Anesthetist
Primary
703282-01
NY
Other
Enumeration date
02/26/2019
Last updated
10/08/2024
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