1235169012 NPI number — SCHENECTADY UROLOGICAL ASSOCIATES, PC

Table of content: DR. PAUL VICTOR GLINIECKI M.D. (NPI 1518137975)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235169012 NPI number — SCHENECTADY UROLOGICAL ASSOCIATES, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SCHENECTADY UROLOGICAL ASSOCIATES, PC
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:
1235169012
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/26/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2200 ROSA RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCHENECTADY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12309-3717
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-374-3341
Provider Business Mailing Address Fax Number:
518-374-6265

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2200 ROSA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCHENECTADY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12309-3717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-374-3341
Provider Business Practice Location Address Fax Number:
518-374-6265
Provider Enumeration Date:
07/04/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RAHMAN
Authorized Official First Name:
SHAHEEN
Authorized Official Middle Name:
B
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
518-374-3341

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00924823 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".