1750376836 NPI number — ST. PETER'S AMBULATORY SURGERY CENTER LLC

Table of content: (NPI 1750376836)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750376836 NPI number — ST. PETER'S AMBULATORY SURGERY CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. PETER'S AMBULATORY SURGERY CENTER LLC
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:
6
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:
1750376836
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1375 WASHINGTON AVE
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
ALBANY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12206-1056
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-533-3420
Provider Business Mailing Address Fax Number:
518-533-3424

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1375 WASHINGTON AVE
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
ALBANY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12206-1056
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-533-3420
Provider Business Practice Location Address Fax Number:
518-533-3424
Provider Enumeration Date:
09/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
TORRE
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
A
Authorized Official Title or Position:
EXECUTIVE DIRECTOR/ADMINISTRATOR
Authorized Official Telephone Number:
518-533-3420

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  261QA1903X , 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)

  • Identifier: 02276511 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com