Provider Demographics
NPI:1407366057
Name:DR KEVIN GEORGE, INCORPORATED
Entity Type:Organization
Organization Name:DR KEVIN GEORGE, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
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:518-867-5319
Mailing Address - Street 1:30 KARNER RD UNIT 13385
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12212-7259
Mailing Address - Country:US
Mailing Address - Phone:518-608-4476
Mailing Address - Fax:
Practice Address - Street 1:1510 CENTRAL AVE STE 375
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-5094
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:2017-10-10
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty