Provider Demographics
NPI:1235474313
Name:ST PETERS HEALTH PARTNERS MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:ST PETERS HEALTH PARTNERS MEDICAL ASSOCIATES
Other - Org Name:PULMONARY & CRITICAL CARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, FIN/ADMIN PHYS ENTERPRISE
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-525-1585
Mailing Address - Street 1:315 S MANNING BLVD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-1707
Mailing Address - Country:US
Mailing Address - Phone:518-525-1585
Mailing Address - Fax:
Practice Address - Street 1:5 PALISADES DR
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-6433
Practice Address - Country:US
Practice Address - Phone:518-438-4496
Practice Address - Fax:518-438-5803
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST PETER'S HEALTH PARTNERS MEDICAL ASSOCIATES, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-11-30
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty