Provider Demographics
NPI:1598049926
Name:COMMUNITY CARE PHYSICIANS, PLLC
Entity Type:Organization
Organization Name:COMMUNITY CARE PHYSICIANS, PLLC
Other - Org Name:COMMUNITY CARE UROLOGY - CLIFTON PARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:M
Authorized Official - Last Name:STAMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-782-3742
Mailing Address - Street 1:6 WELLNESS WAY STE 201
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2156
Mailing Address - Country:US
Mailing Address - Phone:518-782-3700
Mailing Address - Fax:518-782-3799
Practice Address - Street 1:1783 ROUTE 9 STE 203
Practice Address - Street 2:
Practice Address - City:HALFMOON
Practice Address - State:NY
Practice Address - Zip Code:12065-2466
Practice Address - Country:US
Practice Address - Phone:518-383-0937
Practice Address - Fax:518-383-1865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-04
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty