Provider Demographics
NPI:1508279423
Name:NEAL A. BAILALRGEON M.D.F.A.A.F.P
Entity Type:Organization
Organization Name:NEAL A. BAILALRGEON M.D.F.A.A.F.P
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:A
Authorized Official - Last Name:BAILLARGEON
Authorized Official - Suffix:
Authorized Official - Credentials:FAAFP
Authorized Official - Phone:518-758-7252
Mailing Address - Street 1:90 BROAD STREET
Mailing Address - Street 2:
Mailing Address - City:KINDERHOOK
Mailing Address - State:NY
Mailing Address - Zip Code:12106
Mailing Address - Country:US
Mailing Address - Phone:518-758-7252
Mailing Address - Fax:518-758-1963
Practice Address - Street 1:90 BROAD STREET
Practice Address - Street 2:
Practice Address - City:KINDERHOOK
Practice Address - State:NY
Practice Address - Zip Code:12106
Practice Address - Country:US
Practice Address - Phone:518-758-7252
Practice Address - Fax:518-758-1963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00942154Medicaid
NY00942154Medicaid