| Prospect Center | |
|
133 Aviation Rd Queensbury NY 12804-8206 | |
| (518) 798-0170 | |
| (518) 743-0227 |
| Full Name | Prospect Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 133 Aviation Rd, Queensbury, New York |
| Authorized Official Name and Position | Kim L. Heunemann (DIRECTOR OF COMMUNITY & INTERAGENCY) |
| Authorized Official Contact | 5187980170 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prospect Center 133 Aviation Rd Queensbury NY 12804-8206 Ph: (518) 798-0170 | Prospect Center 133 Aviation Rd Queensbury NY 12804-8206 Ph: (518) 798-0170 |
| NPI Number | 1952402448 |
|---|---|
| Provider Enumeration Date | 09/26/2006 |
| Last Update Date | 10/14/2014 |
| Medicare PECOS PAC ID | 2062546179 |
|---|---|
| Medicare Enrollment ID | O20100811000566 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952402448 | NPI | - | NPPES |
| 00752456 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Gary O Guilfoyle |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1588645238 PECOS PAC ID: 0840323846 Enrollment ID: I20100728000128 |
| Provider Name | Bridget C Lieberum |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1528381985 PECOS PAC ID: 3577687466 Enrollment ID: I20100830000374 |
| Provider Name | Linda Miller |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1518110113 PECOS PAC ID: 6507039062 Enrollment ID: I20111027000609 |
| Provider Name | Elizabeth M Mcintyre |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1174833362 PECOS PAC ID: 5092957167 Enrollment ID: I20130820000732 |
| Provider Name | Kristin J Mcgorty |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1689066334 PECOS PAC ID: 4284999780 Enrollment ID: I20180605000633 |
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