Provider Demographics
NPI:1518136001
Name:ADIRONDACK MEDICAL PRACTICE LLC
Entity Type:Organization
Organization Name:ADIRONDACK MEDICAL PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:POLITI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-643-8008
Mailing Address - Street 1:3384 RT 22
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:NY
Mailing Address - Zip Code:12972
Mailing Address - Country:US
Mailing Address - Phone:518-643-8008
Mailing Address - Fax:
Practice Address - Street 1:3384 RT 22
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:NY
Practice Address - Zip Code:12972
Practice Address - Country:US
Practice Address - Phone:518-643-8008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY162323-1207R00000X
NY006858-1363AM0700X
NY009293-1363AM0700X
NYF331788363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA0765Medicare PIN