| Koinonia Primary Care Inc | |
|
553 Clinton Ave Albany NY 12206-2738 | |
| (518) 689-0282 | |
| (518) 689-0283 |
| Full Name | Koinonia Primary Care Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 553 Clinton Ave, Albany, New York |
| Authorized Official Name and Position | Robert John Paeglow (PRESIDENT) |
| Authorized Official Contact | 5186890282 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Koinonia Primary Care Inc 553 Clinton Ave Albany NY 12206-2738 Ph: (518) 689-0282 | Koinonia Primary Care Inc 553 Clinton Ave Albany NY 12206-2738 Ph: (518) 689-0282 |
| NPI Number | 1023389533 |
|---|---|
| Provider Enumeration Date | 01/16/2012 |
| Last Update Date | 01/16/2012 |
| Medicare PECOS PAC ID | 6901041425 |
|---|---|
| Medicare Enrollment ID | O20130403000334 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023389533 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (New York) | Primary |
| Provider Name | Robert J Paeglow |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1568576379 PECOS PAC ID: 3476546862 Enrollment ID: I20050225000350 |
| Provider Name | William Joseph Serafin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1114087756 PECOS PAC ID: 0143130575 Enrollment ID: I20101020000131 |
| Provider Name | Gail Moore |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174935902 PECOS PAC ID: 2769720556 Enrollment ID: I20190221001256 |
| Provider Name | Rachel Siffring |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912550658 PECOS PAC ID: 0446684732 Enrollment ID: I20191219000276 |
| Provider Name | Eliezer Hernandez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679247159 PECOS PAC ID: 1456757541 Enrollment ID: I20210915002814 |
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