Basic Information
| Provider Information | |||||||||
| NPI: | 1366872244 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ALBANY MEDICAL COLLEGE | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ALBANY MED EMURGENTCARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1275 BROADWAY # MC106 | ||||||||
| Address2: | |||||||||
| City: | MENANDS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 122042638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5182629705 | ||||||||
| FaxNumber: | 5182629738 | ||||||||
| Practice Location | |||||||||
| Address1: | 11835 RT 9W | ||||||||
| Address2: | |||||||||
| City: | WEST COXSACKIE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 121923605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5187319000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2013 | ||||||||
| LastUpdateDate: | 04/22/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | VERDILE | ||||||||
| AuthorizedOfficialFirstName: | VINCENT | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DEAN ALBANY MEDICAL COLLEGE | ||||||||
| AuthorizedOfficialTelephone: | 5182626008 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 04/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine | 261QU0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.