Provider Demographics
NPI:1033159975
Name:ALBANY CARDIOTHORACIC SURGEONS
Entity Type:Organization
Organization Name:ALBANY CARDIOTHORACIC SURGEONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:DWYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-525-2545
Mailing Address - Street 1:319 S MANNING BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-1742
Mailing Address - Country:US
Mailing Address - Phone:518-525-2551
Mailing Address - Fax:518-525-2522
Practice Address - Street 1:319 S MANNING BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-1742
Practice Address - Country:US
Practice Address - Phone:518-525-2551
Practice Address - Fax:518-525-2522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00422835Medicaid
NYCA1873OtherRAILROAD MEDICARE
NY00422835Medicaid