Provider Demographics
NPI:1598720369
Name:GLENS FALLS PEDIATRIC CONSULTANTS, PC
Entity Type:Organization
Organization Name:GLENS FALLS PEDIATRIC CONSULTANTS, PC
Other - Org Name:--NONE--
Other - Org Type:Other Name
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BETHEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-798-9985
Mailing Address - Street 1:PO BOX 141
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-0141
Mailing Address - Country:US
Mailing Address - Phone:518-798-9985
Mailing Address - Fax:518-761-7043
Practice Address - Street 1:1 LAWRENCE ST STE 2
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-3618
Practice Address - Country:US
Practice Address - Phone:518-798-9985
Practice Address - Fax:518-761-7043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-17
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty