1659791176 NPI number — DR. JUSTIN ALBERT CARAMICIU MD

Table of content: DR. JUSTIN ALBERT CARAMICIU MD (NPI 1659791176)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659791176 NPI number — DR. JUSTIN ALBERT CARAMICIU MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARAMICIU
Provider First Name:
JUSTIN
Provider Middle Name:
ALBERT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1659791176
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/07/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1450 WESTERN AVE STE 102
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:
12203-3539
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-463-0050
Provider Business Mailing Address Fax Number:
518-207-2973

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
211 CHURCH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SARATOGA SPRINGS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12866-1003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-463-0050
Provider Business Practice Location Address Fax Number:
518-207-2973
Provider Enumeration Date:
04/23/2014

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 , with the licence number:  292623 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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