Provider Demographics
NPI:1407880784
Name:ENGELMYER, ERIC I
Entity Type:Individual
Prefix:MISS
First Name:ERIC
Middle Name:I
Last Name:ENGELMYER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1354 HAWTHORN RD
Mailing Address - Street 2:
Mailing Address - City:NISKAYUNA
Mailing Address - State:NY
Mailing Address - Zip Code:12309-2502
Mailing Address - Country:US
Mailing Address - Phone:518-372-1847
Mailing Address - Fax:
Practice Address - Street 1:2200 ROSA RD
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12309-3717
Practice Address - Country:US
Practice Address - Phone:518-374-3341
Practice Address - Fax:518-374-2329
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY202919208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01668813Medicaid
NYBB2429Medicare ID - Type Unspecified
NYG36624Medicare UPIN