Basic Information
Provider Information
NPI: 1598265613
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ALARCON
FirstName: MAYKOL
MiddleName: G.
NamePrefix:  
NameSuffix:  
Credential: FNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1101 NOTT ST
Address2:  
City: SCHENECTADY
State: NY
PostalCode: 123082425
CountryCode: US
TelephoneNumber: 5182434000
FaxNumber:  
Practice Location
Address1: 1101 NOTT ST
Address2:  
City: SCHENECTADY
State: NY
PostalCode: 123082425
CountryCode: US
TelephoneNumber: 5182434000
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/15/2018
LastUpdateDate: 04/05/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/05/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X342685NYY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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