Provider Demographics
NPI:1659555415
Name:ADULT MEDICINE PC
Entity Type:Organization
Organization Name:ADULT MEDICINE PC
Other - Org Name:ADULT MEDICINE PC PAIN MANAGEMENT SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNA
Authorized Official - Middle Name:P
Authorized Official - Last Name:BOKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-638-6700
Mailing Address - Street 1:1 PINNACLE PLACE
Mailing Address - Street 2:STE 203
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203
Mailing Address - Country:US
Mailing Address - Phone:518-438-4700
Mailing Address - Fax:518-438-3190
Practice Address - Street 1:1 PINNACLE PLACE
Practice Address - Street 2:STE 203
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203
Practice Address - Country:US
Practice Address - Phone:518-438-4700
Practice Address - Fax:518-438-3190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-28
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCC2715Medicare PIN
NYAA0803Medicare PIN