Provider Demographics
NPI:1417391319
Name:MARIUS KILLIAN NIKOLAS DITURSI MD PC
Entity Type:Organization
Organization Name:MARIUS KILLIAN NIKOLAS DITURSI MD PC
Other - Org Name:MARY KATHLEEN W DITURSI MD PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIUS KILLIAN
Authorized Official - Middle Name:NIKOLAS
Authorized Official - Last Name:DITURSI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-233-9500
Mailing Address - Street 1:127 CANVASS ST
Mailing Address - Street 2:
Mailing Address - City:COHOES
Mailing Address - State:NY
Mailing Address - Zip Code:12047-3030
Mailing Address - Country:US
Mailing Address - Phone:518-233-9500
Mailing Address - Fax:518-660-0770
Practice Address - Street 1:127 CANVASS ST
Practice Address - Street 2:
Practice Address - City:COHOES
Practice Address - State:NY
Practice Address - Zip Code:12047-3030
Practice Address - Country:US
Practice Address - Phone:518-233-9500
Practice Address - Fax:518-660-0770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-22
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY263723261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care