Provider Demographics
NPI:1043861974
Name:ALBANY FAMILY MEDICINE PLLC
Entity Type:Organization
Organization Name:ALBANY FAMILY MEDICINE PLLC
Other - Org Name:JOSE M DAVID THE PRACTICE OF FAMILY MEDCINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-456-4634
Mailing Address - Street 1:1 ALTON RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-4253
Mailing Address - Country:US
Mailing Address - Phone:518-456-4634
Mailing Address - Fax:
Practice Address - Street 1:1 ALTON RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-4253
Practice Address - Country:US
Practice Address - Phone:518-456-4634
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-23
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty