Provider Demographics
NPI:1639392871
Name:DURDANA MEHTABDIN
Entity Type:Organization
Organization Name:DURDANA MEHTABDIN
Other - Org Name:GUILDERLAND FAMILY PRACTICE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DURDANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHTABDIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-464-9000
Mailing Address - Street 1:2022 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-5093
Mailing Address - Country:US
Mailing Address - Phone:518-464-9000
Mailing Address - Fax:
Practice Address - Street 1:2022 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-5093
Practice Address - Country:US
Practice Address - Phone:518-464-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA1719Medicare PIN