Provider Demographics
NPI:1285667634
Name:ADIRONDACK PEDIATRICS, P.C.
Entity Type:Organization
Organization Name:ADIRONDACK PEDIATRICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:BRAICO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-798-9538
Mailing Address - Street 1:84 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-4381
Mailing Address - Country:US
Mailing Address - Phone:518-798-9538
Mailing Address - Fax:518-798-9576
Practice Address - Street 1:84 BROAD ST
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-4381
Practice Address - Country:US
Practice Address - Phone:518-798-9538
Practice Address - Fax:518-798-9576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service