1720441215 NPI number — ST. PETER'S HEALTH PARTNERS MEDICAL ASSOCIATES, PC

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 1720441215 NPI number — ST. PETER'S HEALTH PARTNERS MEDICAL ASSOCIATES, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. PETER'S HEALTH PARTNERS MEDICAL 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:
1720441215
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/01/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4 PALISADES DR
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
ALBANY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12205-1449
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-591-1121
Provider Business Mailing Address Fax Number:
518-649-4094

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
55 MOHAWK ST
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
COHOES
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12047-2629
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-235-7282
Provider Business Practice Location Address Fax Number:
518-235-4274
Provider Enumeration Date:
04/01/2016

Additional Information

Authorized Official

Authorized Official Last Name:
MACKE
Authorized Official First Name:
JANICE
Authorized Official Middle Name:
D
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
518-525-6931

Provider Taxonomy Codes

  • Taxonomy code: 207RE0101X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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