Basic Information
| Provider Information | |||||||||
| NPI: | 1760449136 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ASHLEY | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | F. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1462 ERIE BLVD | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | SCHENECTADY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 123051026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5182431500 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1101 NOTT ST | ||||||||
| Address2: | |||||||||
| City: | SCHENECTADY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 123082425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5182434000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0200X | 131933 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | 589101 | 01 | NY | BLUE CROSS | OTHER | 050922000005 | 01 | NY | FIDELIS | OTHER | 10024351 | 01 | NY | CDPHP | OTHER | 10503622 | 01 | NY | CAQH | OTHER | 924015 | 01 | NY | MVP | OTHER | 4799821 | 01 | NY | GHI-PPO | OTHER | 000000046371 | 01 | NY | GHI-HMO | OTHER | 5192147 | 01 | NY | AETNA | OTHER | 000472123001 | 01 | NY | BLUE SHIELD | OTHER |