1679501449 NPI number — JOSEPH SPENCER BORDELON M.D.

Table of content: JOSEPH SPENCER BORDELON M.D. (NPI 1679501449)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679501449 NPI number — JOSEPH SPENCER BORDELON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BORDELON
Provider First Name:
JOSEPH
Provider Middle Name:
SPENCER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1679501449
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/07/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1357
Provider Second Line Business Mailing Address:
ANESTHESIOLOGISTS OF GLENS FALLS
Provider Business Mailing Address City Name:
WILLISTON
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05495-1357
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-720-1664
Provider Business Mailing Address Fax Number:
207-753-2020

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 PARK ST
Provider Second Line Business Practice Location Address:
ANESTHESIA DEPARTMENT
Provider Business Practice Location Address City Name:
GLENS FALLS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12801-4413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-926-5127
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/29/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , 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: 02672686 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00276753 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".