Provider Demographics
NPI:1356488613
Name:SARATOGA GENERAL SURGERY, PLLC
Entity Type:Organization
Organization Name:SARATOGA GENERAL SURGERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:YEATON
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACS
Authorized Official - Phone:518-587-1302
Mailing Address - Street 1:414 MAPLE AVE STE 700
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-5551
Mailing Address - Country:US
Mailing Address - Phone:518-587-1302
Mailing Address - Fax:518-587-3818
Practice Address - Street 1:414 MAPLE AVE STE 700
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-5551
Practice Address - Country:US
Practice Address - Phone:518-587-1302
Practice Address - Fax:518-587-3818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY188144174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10002224OtherCDPHP
NY0074281Medicaid
NY02171OtherMVP
NYBA0295Medicare ID - Type Unspecified
NY0074281Medicaid