Individual
URI NAPCHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
111 MALTESE DR, MIDDLETOWN, NY 10940-2115
(845) 342-4774
(845) 343-8741
Mailing address
111 MALTESE DR, MIDDLETOWN, NY 10940-2115
(845) 342-4774
(845) 343-8741
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
245044
NY
2084P2900X
Pain Medicine (Psychiatry & Neurology) Physician
25MA09545000
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
245044
LICENSE
NY
01
—
25MA09545000
LICENSE
NJ
01
—
A4000399998
MEDICARE
NY
Enumeration date
12/04/2006
Last updated
05/30/2023
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