Basic Information
| Provider Information | |||||||||
| NPI: | 1689669079 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CORNERSTONE FAMILY HEALTHCARE | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | THE GREATER HUDSON VALLEY FAMILY HEALTH CENTER, INC. | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2570 ROUTE 9W | ||||||||
| Address2: | SUITE 10 | ||||||||
| City: | CORNWALL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125181323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8452203100 | ||||||||
| FaxNumber: | 8455342940 | ||||||||
| Practice Location | |||||||||
| Address1: | 147 LAKE STREET | ||||||||
| Address2: | |||||||||
| City: | NEWBURGH | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125505242 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8455638000 | ||||||||
| FaxNumber: | 8455638093 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2005 | ||||||||
| LastUpdateDate: | 05/27/2020 | ||||||||
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| AuthorizedOfficialLastName: | ELLIOTT | ||||||||
| AuthorizedOfficialFirstName: | DASI | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | VP OF REVENUE CYCLE MANAGEMENT | ||||||||
| AuthorizedOfficialTelephone: | 8452203144 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 05/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332S00000X | 000425 | NY | N | Suppliers | Hearing Aid Equipment | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
ID Information
| ID | Type | State | Issuer | Description | 331832 | 01 | NY | MEDICARE ID | OTHER | WCW271 | 01 | NY | MEDICARE ID | OTHER | 00472931 | 05 | NY | MEDICAID |