Basic Information
| Provider Information | |||||||||
| NPI: | 1457987521 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DELAWARE RIVER MEDICINE, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1602 AVENUE Q | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794014732 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 160 E MAIN ST | ||||||||
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| City: | PORT JERVIS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 127712253 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8458587000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2020 | ||||||||
| LastUpdateDate: | 03/20/2020 | ||||||||
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| AuthorizedOfficialLastName: | SHEETS | ||||||||
| AuthorizedOfficialFirstName: | HARRY | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/ PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8067293445 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 03/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist | 207P00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.