1306869672 NPI number — ADIRONDACK HEALTHCARE ASSOCIATES, LLC

Table of content: (NPI 1306869672)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306869672 NPI number — ADIRONDACK HEALTHCARE ASSOCIATES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADIRONDACK HEALTHCARE ASSOCIATES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306869672
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/03/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3384 STATE ROUTE 22
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PERU
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12972-5305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-643-8008
Provider Business Mailing Address Fax Number:
518-643-8090

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3384 STATE ROUTE 22
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PERU
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12972-5305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-643-8008
Provider Business Practice Location Address Fax Number:
518-643-8090
Provider Enumeration Date:
07/26/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MCDONALD
Authorized Official First Name:
AMY
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
518-643-8008

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  162323-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363AM0700X , with the licence number: 006858-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: F331788 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8527 . This is a "CDPHP GROUP NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".