Individual
GEORGE J PROFETA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3078 US ROUTE 9W, NEW WINDSOR, NY 12553-6751
(845) 561-3310
(845) 561-8728
Mailing address
3078 US ROUTE 9W, NEW WINDSOR, NY 12553-6751
(845) 561-3310
(845) 561-8728
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
187693
NY
207RP1001X
Pulmonary Disease Physician
Primary
187693
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01817005
—
NY
01
—
110161854
RR MEDICARE PROVIDER ID
NY
01
—
CE9235
RR MEDICARE
NY
Enumeration date
10/02/2006
Last updated
12/15/2017
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