Provider Demographics
NPI:1700816626
Name:ALBANY MEDICAL COLLEGE
Entity Type:Organization
Organization Name:ALBANY MEDICAL COLLEGE
Other - Org Name:ALBANY MEDICAL COLLEGE DEPT OF PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DEAN
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:P
Authorized Official - Last Name:VERDILE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-262-3773
Mailing Address - Street 1:618 CENTRAL AVE
Mailing Address - Street 2:MAIL CODE 106
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12206-1916
Mailing Address - Country:US
Mailing Address - Phone:518-262-9702
Mailing Address - Fax:518-262-9707
Practice Address - Street 1:1 PINNACLE PL
Practice Address - Street 2:MAIL CODE 58
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-3496
Practice Address - Country:US
Practice Address - Phone:518-262-5735
Practice Address - Fax:518-262-5743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent MedicineGroup - Multi-Specialty
Not Answered207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Multi-Specialty
Not Answered363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01658117Medicaid
VT1006966Medicaid
MA9766804Medicaid
NY01520676Medicaid
MA9766804Medicaid
NYCC3685Medicare ID - Type UnspecifiedRR
NY01658117Medicaid
NYC4772Medicare ID - Type UnspecifiedRR
NY56138AMedicare ID - Type UnspecifiedGROUP
NYCA1523Medicare ID - Type UnspecifiedRR
VT1006966Medicaid
NY01520676Medicaid
NYCB9202Medicare ID - Type UnspecifiedRR
NYC20662Medicare ID - Type UnspecifiedRR
NYDC3884Medicare ID - Type UnspecifiedRR