1316499452 NPI number — COLONIE ASC LLC

Table of content: (NPI 1316499452)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316499452 NPI number — COLONIE ASC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLONIE ASC 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:
SPECIALTY EYE SURGERY & LASER CENTER OF THE CAPITAL REGION
Provider Other Organization Name Type Code:
3
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:
1316499452
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/12/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
207 TROY SCHENECTADY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LATHAM
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12110-5446
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-538-9128
Provider Business Mailing Address Fax Number:
518-389-2933

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
207 TROY-SCHENECTADY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLONIE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-423-7784
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/25/2016

Additional Information

Authorized Official

Authorized Official Last Name:
WLADIS
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
J
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
518-423-7784

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com