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4164 Route 2 Cropseyville NY 12502 | |
(518) 213-0450 | |
(518) 279-1716 |
Full Name | |
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Speciality | Family Medicine |
Location | 4164 Route 2, Cropseyville, New York |
Authorized Official Name and Position | Diane M Stamas (SENIOR CREDENTIALING COORDINATOR) |
Authorized Official Contact | 5187823742 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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711 Troy Schenectady Rd Suite 203 Latham NY 12110-2442 Ph: (518) 782-3700 | 4164 Route 2 Cropseyville NY 12502 Ph: (518) 213-0450 |
NPI Number | 1043593890 |
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Provider Enumeration Date | 09/27/2011 |
Last Update Date | 09/27/2011 |
Identifier | Type | State | Issuer |
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1043593890 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | 154004 (New York) | Primary |