1760727325 NPI number — ST PETERS HEALTH PARTNERS MEDICAL ASSOCIATES, PC

Table of content: BONNIE TAFT RN, CPNP (NPI 1780878132)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760727325 NPI number — ST PETERS HEALTH PARTNERS MEDICAL ASSOCIATES, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST PETERS 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:
63 SHAKER ROAD-SUITE 102
Provider Other Organization Name Type Code:
5
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:
1760727325
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/21/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
315 S MANNING BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBANY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12208-1707
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-525-1585
Provider Business Mailing Address Fax Number:
518-525-6199

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
63 ALBANY SHAKER RD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
ALBANY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12204-1030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-207-2710
Provider Business Practice Location Address Fax Number:
518-207-2713
Provider Enumeration Date:
12/07/2012

Additional Information

Authorized Official

Authorized Official Last Name:
GORDON
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
Authorized Official Title or Position:
DIR FIN/ADMIN PHYS ENTERPRISE
Authorized Official Telephone Number:
518-525-1585

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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