Provider Demographics
NPI:1093160822
Name:ST. PETER'S HEALTH PARTNERS MEDICAL ASSOCIATES, PC
Entity Type:Organization
Organization Name:ST. PETER'S HEALTH PARTNERS MEDICAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:MACKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-525-6931
Mailing Address - Street 1:4 PALISADES DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-1449
Mailing Address - Country:US
Mailing Address - Phone:518-591-1121
Mailing Address - Fax:518-649-4094
Practice Address - Street 1:2 EMPIRE DR
Practice Address - Street 2:
Practice Address - City:RENSSELAER
Practice Address - State:NY
Practice Address - Zip Code:12144-5730
Practice Address - Country:US
Practice Address - Phone:518-286-4960
Practice Address - Fax:518-286-4959
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. PETER'S HEALTH PARTNERS MEDICAL ASSOCIATES, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-29
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty