New Season Wellness Family Health Np Pllc | |
418 Broadway Ste N Albany NY 12207-2922 | |
(347) 455-4509 | |
Not Available |
Full Name | New Season Wellness Family Health Np Pllc |
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Speciality | Clinic/Center |
Location | 418 Broadway Ste N, Albany, New York |
Authorized Official Name and Position | Gertha Boucicault (OWNER) |
Authorized Official Contact | 3474554509 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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New Season Wellness Family Health Np Pllc 418 Broadway Ste N Albany NY 12207-2922 Ph: (347) 455-4509 | New Season Wellness Family Health Np Pllc 418 Broadway Ste N Albany NY 12207-2922 Ph: (347) 455-4509 |
NPI Number | 1770309734 |
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Provider Enumeration Date | 11/25/2024 |
Last Update Date | 11/25/2024 |
Medicare PECOS PAC ID | 6901332956 |
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Medicare Enrollment ID | O20241213001002 |
Identifier | Type | State | Issuer |
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1770309734 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261Q00000X | Clinic/center | (* (Not Available)) | Primary |
Provider Name | Gertha Boucicault |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1619285814 PECOS PAC ID: 3870917560 Enrollment ID: I20200728002804 |
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 |