Provider Demographics
NPI:1710269907
Name:COMMUNITY CARE PHYSICIANS, PC
Entity Type:Organization
Organization Name:COMMUNITY CARE PHYSICIANS, PC
Other - Org Name:COMMUNITY CARE PEDIATRICS - MALTA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:M
Authorized Official - Last Name:STAMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-782-3742
Mailing Address - Street 1:5 HEMPHILL PL
Mailing Address - Street 2:BUILDING 3, SUITE 123
Mailing Address - City:MALTA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-4422
Mailing Address - Country:US
Mailing Address - Phone:518-584-0355
Mailing Address - Fax:518-583-7665
Practice Address - Street 1:711 TROY SCHENECTADY RD
Practice Address - Street 2:SUITE 203
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-2442
Practice Address - Country:US
Practice Address - Phone:518-782-3700
Practice Address - Fax:518-782-3799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206716208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty