Provider Demographics
NPI: | 1629008537 |
---|---|
Name: | ALBANY MEDICAL COLLEGE |
Entity Type: | Organization |
Organization Name: | ALBANY MEDICAL COLLEGE |
Other - Org Name: | ALBANY MEDICAL COLLEGE DEPT OF PM&R |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | DEAN |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | VINCENT |
Authorized Official - Middle Name: | P |
Authorized Official - Last Name: | VERDILE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 518-262-6008 |
Mailing Address - Street 1: | 1275 BROADWAY # 106 |
Mailing Address - Street 2: | |
Mailing Address - City: | MENANDS |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 12204-2638 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 518-262-9705 |
Mailing Address - Fax: | 518-262-9638 |
Practice Address - Street 1: | 47 NEW SCOTLAND AVE |
Practice Address - Street 2: | MAIL CODE 61 |
Practice Address - City: | ALBANY |
Practice Address - State: | NY |
Practice Address - Zip Code: | 12208-3412 |
Practice Address - Country: | US |
Practice Address - Phone: | 518-262-6517 |
Practice Address - Fax: | 518-262-0871 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-07-04 |
Last Update Date: | 2020-04-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
No | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | Group - Multi-Specialty | |
No | 207P00000X | Allopathic & Osteopathic Physicians | Emergency Medicine | Group - Multi-Specialty | |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
No | 2081P0004X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Spinal Cord Injury Medicine | Group - Multi-Specialty |
No | 2081P0010X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pediatric Rehabilitation Medicine | Group - Multi-Specialty |
No | 2081P2900X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine | Group - Multi-Specialty |
No | 2081S0010X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Sports Medicine | Group - Multi-Specialty |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MA | 9766804 | Medicaid | |
NY | 01520676 | Medicaid | |
VT | 1006966 | Medicaid | |
MA | 9766804 | Medicaid | |
NY | 52466A | Medicare ID - Type Unspecified | GROUP |
NY | CA1523 | Medicare ID - Type Unspecified | RR |