Provider Demographics
NPI:1659758928
Name:SARATOGA HOSPITAL
Entity Type:Organization
Organization Name:SARATOGA HOSPITAL
Other - Org Name:CARDIOLOGY-MALTA
Other - Org Type:Other Name
Authorized Official - Title/Position:VP/CFO
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-583-8421
Mailing Address - Street 1:6 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:MALTA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-5051
Mailing Address - Country:US
Mailing Address - Phone:518-886-5080
Mailing Address - Fax:518-886-5805
Practice Address - Street 1:6 MEDICAL PARK DR
Practice Address - Street 2:SUITE 205
Practice Address - City:MALTA
Practice Address - State:NY
Practice Address - Zip Code:12020-5051
Practice Address - Country:US
Practice Address - Phone:518-886-5080
Practice Address - Fax:518-886-5805
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SARATOGA HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-05-06
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03849694Medicaid
NY03849694Medicaid