Provider Demographics
NPI:1699842872
Name:MEDICAL ASSOCIATES OF SARANAC LAKE PC
Entity Type:Organization
Organization Name:MEDICAL ASSOCIATES OF SARANAC LAKE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:S
Authorized Official - Last Name:FEDERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-891-4000
Mailing Address - Street 1:118 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:SARANAC LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12983-1705
Mailing Address - Country:US
Mailing Address - Phone:518-891-4000
Mailing Address - Fax:518-891-2598
Practice Address - Street 1:118 MAIN STREET
Practice Address - Street 2:
Practice Address - City:SARANAC LAKE
Practice Address - State:NY
Practice Address - Zip Code:12983-1705
Practice Address - Country:US
Practice Address - Phone:518-891-4000
Practice Address - Fax:518-891-2598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00402855Medicaid
NYCK1320OtherRAILROAD MEDICARE
NYCK1320OtherRAILROAD MEDICARE