Provider Demographics
NPI:1760894208
Name:NEAL A BAILLARGEON
Entity Type:Organization
Organization Name:NEAL A BAILLARGEON
Other - Org Name:PHILMONT FAMILY PRACTICE
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSCIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:BAILLARGEON
Authorized Official - Suffix:
Authorized Official - Credentials:MD,FAAFP
Authorized Official - Phone:518-758-7252
Mailing Address - Street 1:PO BOX 766
Mailing Address - Street 2:90 BROAD STREET
Mailing Address - City:KINDERHOOK
Mailing Address - State:NY
Mailing Address - Zip Code:12106-0766
Mailing Address - Country:US
Mailing Address - Phone:518-758-7252
Mailing Address - Fax:151-875-8193
Practice Address - Street 1:90 BROAD STREET
Practice Address - Street 2:
Practice Address - City:KINDERHOOK
Practice Address - State:NY
Practice Address - Zip Code:12106-0766
Practice Address - Country:US
Practice Address - Phone:518-758-7252
Practice Address - Fax:151-875-8193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-02
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY161495207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00942154Medicaid
NYA63594Medicare UPIN