Provider Demographics
NPI:1679698872
Name:ADIRONDACK MEDICAL CENTER
Entity Type:Organization
Organization Name:ADIRONDACK MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED ATHLETIC TRAINER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MUSCATELLO
Authorized Official - Suffix:
Authorized Official - Credentials:ATC
Authorized Official - Phone:518-359-2479
Mailing Address - Street 1:254 STATE ROUTE 86
Mailing Address - Street 2:
Mailing Address - City:PAUL SMITHS
Mailing Address - State:NY
Mailing Address - Zip Code:12970-1801
Mailing Address - Country:US
Mailing Address - Phone:518-327-5058
Mailing Address - Fax:
Practice Address - Street 1:47 PARK ST
Practice Address - Street 2:SUITE #1
Practice Address - City:TUPPER LAKE
Practice Address - State:NY
Practice Address - Zip Code:12986-1616
Practice Address - Country:US
Practice Address - Phone:518-359-2479
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2255A2300X282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital