Full Name | |
---|---|
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 |
---|---|
553 Clinton Avenue Albany NY 12206 Ph: (518) 689-0282 | 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 |
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 |