Empire State Physician Pllc | |
180 Washington Avenue Ext Albany NY 12203-5304 | |
(518) 456-7831 | |
Not Available |
Full Name | Empire State Physician Pllc |
---|---|
Speciality | Internal Medicine |
Location | 180 Washington Avenue Ext, Albany, New York |
Authorized Official Name and Position | Edgar R Henriques (OWNER) |
Authorized Official Contact | 5184330205 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Empire State Physician Pllc 11 Ruso Dr Menands NY 12204-1313 Ph: (518) 433-0205 | Empire State Physician Pllc 180 Washington Avenue Ext Albany NY 12203-5304 Ph: (518) 456-7831 |
NPI Number | 1427394428 |
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Provider Enumeration Date | 12/19/2012 |
Last Update Date | 12/19/2012 |
Medicare PECOS PAC ID | 6002057742 |
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Medicare Enrollment ID | O20130723000816 |
Identifier | Type | State | Issuer |
---|---|---|---|
1427394428 | NPI | - | NPPES |
02529371 | Medicaid | NY |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | 231783 (New York) | Primary |
Provider Name | Edgar Henriques |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1508868415 PECOS PAC ID: 9436131919 Enrollment ID: I20040607001349 |
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