Provider Demographics
NPI:1114050390
Name:PSYCHOPHARMACOLOGY CONSULTANTS OF ALBANY, PLLC
Entity Type:Organization
Organization Name:PSYCHOPHARMACOLOGY CONSULTANTS OF ALBANY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-458-2481
Mailing Address - Street 1:110 WOLF RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:COLONIE
Mailing Address - State:NY
Mailing Address - Zip Code:12205-1244
Mailing Address - Country:US
Mailing Address - Phone:518-458-2481
Mailing Address - Fax:518-489-4149
Practice Address - Street 1:110 WOLF RD
Practice Address - Street 2:SUITE 5
Practice Address - City:COLONIE
Practice Address - State:NY
Practice Address - Zip Code:12205-1244
Practice Address - Country:US
Practice Address - Phone:518-458-2481
Practice Address - Fax:518-489-4149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2014392084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA0137Medicare PIN
NYG76059Medicare UPIN