Provider Demographics
NPI:1447392949
Name:COHOES PHYSICIANS PC
Entity Type:Organization
Organization Name:COHOES PHYSICIANS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MED DIRECTOR OF COHOES PHYSICIANS
Authorized Official - Prefix:
Authorized Official - First Name:BERNARDO
Authorized Official - Middle Name:S
Authorized Official - Last Name:EVANGELISTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-237-2911
Mailing Address - Street 1:244 ONTARIO ST
Mailing Address - Street 2:
Mailing Address - City:COHOES
Mailing Address - State:NY
Mailing Address - Zip Code:12047-2868
Mailing Address - Country:US
Mailing Address - Phone:518-237-2911
Mailing Address - Fax:518-237-2911
Practice Address - Street 1:244 ONTARIO ST
Practice Address - Street 2:
Practice Address - City:COHOES
Practice Address - State:NY
Practice Address - Zip Code:12047-2868
Practice Address - Country:US
Practice Address - Phone:518-237-2911
Practice Address - Fax:518-237-2911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1291OtherCDPHP
NYSG325OtherEMPIRE BCBS
NY0030500OtherTHE EMPIRE PLAN
NY0101620OtherGHI
NY0101620OtherGHI