Provider Demographics
NPI:1093749970
Name:ALBANY MEDICAL COLLEGE
Entity Type:Organization
Organization Name:ALBANY MEDICAL COLLEGE
Other - Org Name:ALBANY MEDICAL COLLEGE DEPT OF OPHTHALMOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DEAN
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:P
Authorized Official - Last Name:VERDILE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-262-6008
Mailing Address - Street 1:1275 BROADWAY # MC106
Mailing Address - Street 2:
Mailing Address - City:MENANDS
Mailing Address - State:NY
Mailing Address - Zip Code:12204-2638
Mailing Address - Country:US
Mailing Address - Phone:518-262-9705
Mailing Address - Fax:518-262-9638
Practice Address - Street 1:47 NEW SCOTLAND AVE
Practice Address - Street 2:MC77
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3412
Practice Address - Country:US
Practice Address - Phone:518-262-2520
Practice Address - Fax:518-262-2516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01226911Medicaid
NY01520676Medicaid
VT1006966Medicaid
MA9766804Medicaid
NY55067AMedicare ID - Type UnspecifiedGROUP
MA9766804Medicaid
NY01226911Medicaid