1275635591 NPI number — GLENS FALLS OBSTETRICS & GYNECOLOGY PC

Table of content: (NPI 1275635591)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275635591 NPI number — GLENS FALLS OBSTETRICS & GYNECOLOGY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GLENS FALLS OBSTETRICS & GYNECOLOGY 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:
1275635591
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
28 SO WESTERN AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
QUEENSBURY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12804
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-798-6165
Provider Business Mailing Address Fax Number:
518-798-0658

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
28 S WESTERN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
QUEENSBURY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12804-3323
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-798-6165
Provider Business Practice Location Address Fax Number:
518-798-0658
Provider Enumeration Date:
09/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PROVOST
Authorized Official First Name:
DOUGLAS
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
518-798-6165

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com