Provider Demographics
NPI:1669819728
Name:GLENS FALLS
Entity Type:Organization
Organization Name:GLENS FALLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIABETIC NURSE EDUCATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:M
Authorized Official - Last Name:DIDIO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:518-929-2613
Mailing Address - Street 1:102 PARK ST STE 3
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-4449
Mailing Address - Country:US
Mailing Address - Phone:518-926-2613
Mailing Address - Fax:
Practice Address - Street 1:102 PARK ST STE 3
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-4449
Practice Address - Country:US
Practice Address - Phone:518-926-2613
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-30
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY397457282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital