Full Name | |
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Speciality | Family Medicine |
Location | 1 Alton Rd, Albany, New York |
Authorized Official Name and Position | Jennifer Martin (PRACTICE MANAGER) |
Authorized Official Contact | 5184564634 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1 Alton Rd Albany NY 12203-4253 Ph: (518) 456-4634 | 1 Alton Rd Albany NY 12203-4253 Ph: (518) 456-4634 |
NPI Number | 1043861974 |
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Provider Enumeration Date | 09/23/2019 |
Last Update Date | 11/08/2019 |
Medicare PECOS PAC ID | 8628400017 |
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Medicare Enrollment ID | O20191125001243 |
Identifier | Type | State | Issuer |
---|---|---|---|
1043861974 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Provider Name | Jose M David |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1831181981 PECOS PAC ID: 4284609355 Enrollment ID: I20040901000168 |
Memorial Hospital, Albany, N.y. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 63 Shaker Rd Ste G02, Albany, NY 12204 Phone: 518-449-5352 |