Provider Demographics
NPI:1477625663
Name:DIGESTIVE DISEASE ASSOC OF SCHENECTADY
Entity Type:Organization
Organization Name:DIGESTIVE DISEASE ASSOC OF SCHENECTADY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:M
Authorized Official - Last Name:HAFLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-382-1153
Mailing Address - Street 1:2147 EASTERN PKWY
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12309-6350
Mailing Address - Country:US
Mailing Address - Phone:518-382-1153
Mailing Address - Fax:518-370-1980
Practice Address - Street 1:2147 EASTERN PKWY
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12309-6350
Practice Address - Country:US
Practice Address - Phone:518-382-1153
Practice Address - Fax:518-370-1980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY124426174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF98791Medicare UPIN
NYB81959Medicare UPIN
NYG12767Medicare UPIN
NYCC1392Medicare UPIN
NYF54428Medicare UPIN