Provider Demographics
NPI:1457306276
Name:SARATOGA FAMILY PHYSICIANS
Entity Type:Organization
Organization Name:SARATOGA FAMILY PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOELLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-886-5800
Mailing Address - Street 1:PO BOX 347332
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15251-4332
Mailing Address - Country:US
Mailing Address - Phone:518-886-5800
Mailing Address - Fax:518-886-5805
Practice Address - Street 1:3040 ROUTE 50
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-2906
Practice Address - Country:US
Practice Address - Phone:518-886-5800
Practice Address - Fax:518-886-5805
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SARATOGA HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-23
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY200876207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA0600Medicare ID - Type UnspecifiedMEDICARE GROUP #
NYJ400040641Medicare PIN