1003691064 NPI number — HUDSON HEADWATERS HEALTH NETWORK

Table of content: (NPI 1003691064)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003691064 NPI number — HUDSON HEADWATERS HEALTH NETWORK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HUDSON HEADWATERS HEALTH NETWORK
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:
1003691064
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9 CAREY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
QUEENSBURY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12804-7880
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-761-0300
Provider Business Mailing Address Fax Number:
518-824-2388

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16 3RD ST STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MALONE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12953-1367
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-824-2562
Provider Business Practice Location Address Fax Number:
833-941-5091
Provider Enumeration Date:
08/29/2023

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PASCO
Authorized Official First Name:
LAURA
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE VP, CFO
Authorized Official Telephone Number:
518-761-0300

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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