Provider Demographics
NPI:1073760385
Name:COMMUNITY CARE PHYSICIANS, PC
Entity Type:Organization
Organization Name:COMMUNITY CARE PHYSICIANS, PC
Other - Org Name:IMAGECARE GUILDERLAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBBY
Authorized Official - Middle Name:
Authorized Official - Last Name:COONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-213-0478
Mailing Address - Street 1:711 TROY SCHENECTADY RD STE 203
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2461
Mailing Address - Country:US
Mailing Address - Phone:518-782-3700
Mailing Address - Fax:518-782-3799
Practice Address - Street 1:3757 CARMAN RD
Practice Address - Street 2:SUITE 102
Practice Address - City:GUILDERLAND
Practice Address - State:NY
Practice Address - Zip Code:12303
Practice Address - Country:US
Practice Address - Phone:518-881-1188
Practice Address - Fax:518-881-1192
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY CARE PHYSICIANS, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-19
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1764172085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01322398Medicaid
NYF26778Medicare UPIN
NY01322398Medicaid