Provider Demographics
NPI: | 1750315636 |
---|---|
Name: | ALBANY MEDICAL COLLEGE |
Entity Type: | Organization |
Organization Name: | ALBANY MEDICAL COLLEGE |
Other - Org Name: | ALBANY MEDICAL COLLEGE DEPARTMENT OF PEDIATRICS |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | DEAN |
Authorized Official - Prefix: | |
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: | 1275 BROADWAY # MC106 |
Mailing Address - Street 2: | |
Mailing Address - City: | MENANDS |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 12204-2638 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 518-262-9705 |
Mailing Address - Fax: | 518-262-9638 |
Practice Address - Street 1: | 47 NEW SCOTLAND AVE |
Practice Address - Street 2: | MC 88 |
Practice Address - City: | ALBANY |
Practice Address - State: | NY |
Practice Address - Zip Code: | 12208-3412 |
Practice Address - Country: | US |
Practice Address - Phone: | 518-262-5333 |
Practice Address - Fax: | 518-262-4933 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-07-10 |
Last Update Date: | 2020-04-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
No | 2080N0001X | Allopathic & Osteopathic Physicians | Pediatrics | Neonatal-Perinatal Medicine | Group - Multi-Specialty |
No | 2080P0202X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Cardiology | Group - Multi-Specialty |
No | 2080P0203X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Critical Care Medicine | Group - Multi-Specialty |
No | 2080P0205X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Endocrinology | Group - Multi-Specialty |
No | 2080P0206X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Gastroenterology | Group - Multi-Specialty |
No | 2080P0207X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Hematology-Oncology | Group - Multi-Specialty |
No | 2080P0208X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Infectious Diseases | Group - Multi-Specialty |
No | 2080P0210X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Nephrology | Group - Multi-Specialty |
No | 2080P0214X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Pulmonology | Group - Multi-Specialty |
No | 2080P0216X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Rheumatology | Group - Multi-Specialty |
No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NY | 01226993 | Medicaid | |
NY | 01520676 | Medicaid | |
VT | 1006966 | Medicaid | |
MA | 9766804 | Medicaid | |
VT | 1006966 | Medicaid | |
NY | 01520676 | Medicaid | |
NY | 01226993 | Medicaid |