| Koinonia Primary Care And Psychiatric Services | |
|
553 Clinton Avenue Albany NY 12206 | |
| (518) 689-0282 | |
| Not Available |
| Full Name | Koinonia Primary Care And Psychiatric Services |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 553 Clinton Avenue, Albany, New York |
| Authorized Official Name and Position | Robert John Paeglow (DIRECTOR) |
| Authorized Official Contact | 5186890282 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Koinonia Primary Care And Psychiatric Services 553 Clinton Avenue Albany NY 12206 Ph: (518) 689-0282 | Koinonia Primary Care And Psychiatric Services 553 Clinton Avenue Albany NY 12206 Ph: (518) 689-0282 |
| NPI Number | 1225122054 |
|---|---|
| Provider Enumeration Date | 10/03/2006 |
| Last Update Date | 11/03/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225122054 | NPI | - | NPPES |
| 01753680 | Medicaid | NY | |
| G9202 | Other | NY | CDPHP GROUP |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 60/201542 (New York) | Primary |
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