1902297641 NPI number — STATE UNIVERSITY OF NEW YORK AT ALBANY

Table of content: KATY ANN FERGUSON MS, LAT, ATC (NPI 1497145353)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902297641 NPI number — STATE UNIVERSITY OF NEW YORK AT ALBANY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STATE UNIVERSITY OF NEW YORK AT ALBANY
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:
1902297641
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1400 WASHINGTON AVE
Provider Second Line Business Mailing Address:
STUDENT HEALTH SERVICES
Provider Business Mailing Address City Name:
ALBANY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12222
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-442-5463
Provider Business Mailing Address Fax Number:
518-442-5444

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 WASHINGTON AVE
Provider Second Line Business Practice Location Address:
STUDENT HEALTH SERVICES
Provider Business Practice Location Address City Name:
ALBANY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-442-5463
Provider Business Practice Location Address Fax Number:
518-442-5444
Provider Enumeration Date:
02/17/2015

Additional Information

Authorized Official

Authorized Official Last Name:
MARINO
Authorized Official First Name:
GERARD
Authorized Official Middle Name:
B
Authorized Official Title or Position:
UNIVERSITY CONTROLLER
Authorized Official Telephone Number:
518-956-8095

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  022074 , 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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