Provider Demographics
NPI:1508924283
Name:ADIRONDACK NEPHROLOGY PC
Entity Type:Organization
Organization Name:ADIRONDACK NEPHROLOGY PC
Other - Org Name:JOSEPH C MIHINDU
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:CARLTON
Authorized Official - Last Name:MIHINDU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-798-3838
Mailing Address - Street 1:20 MURRAY ST
Mailing Address - Street 2:PO BOX 2018
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-4320
Mailing Address - Country:US
Mailing Address - Phone:518-798-3838
Mailing Address - Fax:518-798-6125
Practice Address - Street 1:20 MURRAY STREET
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-2018
Practice Address - Country:US
Practice Address - Phone:518-798-3838
Practice Address - Fax:518-798-6125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1550461207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00819109Medicaid
11248OtherMVP
10001370OtherCDPHP
000411366001OtherBCBS NENY
106AR1OtherEMPIRE HEALTHCARE
10001370OtherCDPHP
NY00819109Medicaid