1417214453 NPI number — SARATOGA SCHENECTADY GASTROENTEROLOGY ASSOCIATES, P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417214453 NPI number — SARATOGA SCHENECTADY GASTROENTEROLOGY ASSOCIATES, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SARATOGA SCHENECTADY GASTROENTEROLOGY ASSOCIATES, P.C.
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:
1417214453
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/16/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
848 ROUTE 50
Provider Second Line Business Mailing Address:
PO BOX 569
Provider Business Mailing Address City Name:
BURNT HILLS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12027-0569
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-831-1500
Provider Business Mailing Address Fax Number:
518-377-1677

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
254 CHURCH ST
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
SARATOGA SPRINGS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12866-1037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-831-1500
Provider Business Practice Location Address Fax Number:
518-377-1677
Provider Enumeration Date:
04/16/2012

Additional Information

Authorized Official

Authorized Official Last Name:
MYERS
Authorized Official First Name:
MOLLIE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
518-831-1500

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  136267 , 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)





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