Provider Demographics
NPI:1417214453
Name:SARATOGA SCHENECTADY GASTROENTEROLOGY ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:SARATOGA SCHENECTADY GASTROENTEROLOGY ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MOLLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-831-1500
Mailing Address - Street 1:848 ROUTE 50
Mailing Address - Street 2:PO BOX 569
Mailing Address - City:BURNT HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:12027-0569
Mailing Address - Country:US
Mailing Address - Phone:518-831-1500
Mailing Address - Fax:518-377-1677
Practice Address - Street 1:254 CHURCH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-1037
Practice Address - Country:US
Practice Address - Phone:518-831-1500
Practice Address - Fax:518-377-1677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-16
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY136267207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY30243AMedicare UPIN